Patient Estimates


I acknowledge that this is just an estimate of what I would pay based on the information I have provided at this time and the estimate does not represent a guarantee of the charges or the amount I will pay. I acknowledge that the information provided is based on information available to Marshall Medical Center as of today. I acknowledge that the actual price may be higher or lower than this estimate due to unforeseen events such as: additional tests or procedures requested or performed by the provider, recent adjustments to deductible or out of pocket liability due to use of benefits, test results that may require additional tests, if applicable the contract terms in place at the time of service with my insurance carrier, claims processed by my insurance that may affect my benefits including but not limited to deductible or out of pocket liability. I understand that if I need a more detailed estimate, I should contact my insurance plan.

Accept and continue