| $4,155.00 |
Total
Obstetrical Care – this includes all
prenatal visits, vaginal
delivery and post-partum care.
|
| |
|
| $4,
860.00 |
Total
Obstetrical Care – this includes all
prenatal visits, primary
and repeat cesarean sections and post-partum
care.
|
| |
|
| $5,000.00 |
Total
Obstetrical Care for High Risk Pregnancies –
this
includes
all prenatal visits, delivery and post-partum
care.
|
| |
|
| $500.00 |
Circumcision |
PAYMENT:
We expect monthly payments to be made towards
your obstetrical fee.
If you do not have maternity coverage, monthly
payments of $700.00 are expected to be paid at the
time of your monthly visit.
If you are covered by a commercial insurance
company and have maternity benefits your monthly
payments should be paid as $200.00 at the time of your
monthly visit. This
will insure that your balance will be paid in full by
your expected date of delivery.
Any over payment we receive will be refunded to
you immediately.
INSURANCE:
Please bring your forms, with your portion
completed. We
will file them and
process them at the time of your delivery.
ADDITIONAL
FEES: Any
lab work, ultrasounds, non-stress tests, etc. are not
included in the above-stated fees.
Payment for such is expected and required at
the time of these services.
The
above policies have been explained to me, and I agree
to all the above information
that has been stated and agreed upon.
SIGNATURE:_________________________
DATE:______________________
|
