To comply with CMS price transparency requirements, a listing of hospital charges can be found on the attachment. This information is a best estimate and not a guarantee of what you will be charged. Based on your unique medical condition and medical needs, as determined by your physician, the actual charges will be either lower or higher than the estimates on this website. The hospital determines its standard charges for patient services with the use of a chargemaster or similar system, which is a list of charges for the components of patient care that go into every patient’s bill. These are baseline rates for services provided at the hospital. The chargemaster rates are updated from time to time to accurately reflect the hospital’s expenses to operate. The baseline charges set forth in the attachment do not necessarily reflect what you will pay. Your final bill will include charges for the actual services provided to you. The actual charges will depend upon a variety of factors such as:

• The length of time spent in surgery or recovery
• The number of days spent in the hospital
• Specific equipment
• Supplies and medications required
• Additional tests required by your physician
• And/or any unusual special care or unexpected conditions or complications
• Benefit Plans
• Contracted rates with government insurance or commercial insurance payors

Importantly, these estimates do not include any physician or provider fees (e.g. office visit, surgeon, anesthesiologist, emergency room physician, radiologist, pathologist, hospitalist, consulting physicians, nurse practitioners, etc.). If you have insurance, your benefits will ultimately determine the amount you owe (including deductibles, co-pay, co-insurance, and out-of-pocket maximums).

Note: The estimated cost is not a guarantee of insurance coverage. Please check with your insurance company if you need help understanding your benefits for the service chosen.

I HAVE READ THE DISCLAIMER AND UNDERSTAND THE INFORMATION ON THE FOLLOWING PAGES IS AN ESTIMATE ONLY. THE ACTUAL AMOUNT THAT I WILL BE REQUIRED TO PAY MAY BE, AND LIKELY WILL BE, DIFFERENT.