ASSOCIATED RETINAL CONSULTANTS, PC SURGICAL FEE SCHEDULE PRELIMINARY TREATMENT COST FOR DRS. TRESE, CAPONE, & DRENSER: The following is an estimate of the main expenses that you will incur during your medical evaluation and potential surgery. Please note that all amounts are subject to change and that the funds are payable in U.S. currency only. Physician Expenses (PAYABLE BEFORE ADMIT): INITIAL OFFICE VISIT $350.00 CHARGE, PER SURGERY $8,900.00 (per surgery) NOTE: These expenses are for one eye. If both eyes have surgery, then these same charges would be billed for the second eye. Additional Hospital Expenses (PAYABLE BEFORE ADMIT): EACH ADMISSION $7,900.00 (per surgery) TOTAL APPROXIMATE MEDICAL EXPENSES FOR SURGERY ON ONE EYE $16,800.00 (Includes physician expenses & approx. hospital charges) GUEST SERVICES / WILLIAM BEAUMONT HOSPITAL 248 898 8100 / DEVIN LIPPERT ASHLEY CORWIN Let the ladies know that you will be patient’s of Dr Trese, Dr Capone or Dr Drenser and you will need Assistance with transportation and lodging, you will be in Michigan approximately three weeks It would be wonderful if this list could include all the costs associated with your visit. However, during your stay with us, there could be tests ordered and personal expenses incurred in addition to the ones accounted for in the above estimates. METHOD OF PAYMENT: As your expenses will have to be settled with different providers and accounts, it is important that you are able to distribute your funds accordingly. This means that you must have a sufficient number of checks to be made out for each type of expense. For example, a separate check must be made to Dr. Trese, Capone, or Drenser, another one for William Beaumont Hospital, and yet another one for the hotel where you are staying. PAYMENT TO DR. TRESE, CAPONE, OR DRENSER AND PAYMENT TO THE HOSPITAL MUST BE MADE BEFORE THE SURGERY - Please do not bring one check for all the expenses.