Jeff Davis Hospital

163 S. Tallahassee St.

Hazlehurst, GA 31539

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You are requesting an estimate for a test and/or procedure at Jeff Davis Hospital. This estimate is for the specific test you are requesting only. There may be additional, incidental charges that are necessary for performing the procedure/test. The estimate is in no way an indication of the final bill, as expenses vary depending on your doctor’s treatment and your health care needs.

The estimated patient cost is based on the information you will enter. If you have met all or part of your deductible or out-of-pocket expenses, that actual amount you owe may be different, The estimated cost is not a guarantee or insurance coverage and you will need to check with your insurance carrier if you need assistance in understanding your benefits.

I have read and understand the above disclaimer and limitations and I fully understand. This is only an estimate and my actual charges may be different from the estimate.

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