Good Faith Estimate (GFE)  – No Surprises Act Compliance

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Provider/Facility Name: Janet Benedict PT, DPT, CLT-LANA; Certified Lymphatics PLLC
NPI Number: 1346414893
 

Total Estimated Charges:  Evaluations $200-$300, Treatments/Wellness Visits $150-$270, Consultations $50-$100

🔸 This estimate includes all reasonably expected items or services related to your health care services (e.g., therapist’s time, facility fees, etc). It does not include any bandaging supplies or compression garments.
🔸 Treatment time and number of visits will vary depending on the severity of your symptoms.

• This Good Faith Estimate is based on the information known at the time of scheduling and may not reflect final charges.

• You have the right to dispute the bill if it is at least $400 more than this estimate.

• For more information about your rights, visit: www.cms.gov/nosurprises

Dispute Resolution Notice

If the actual billed charges are at least $400 more than the Good Faith Estimate, you may initiate a patient-provider dispute resolution process.
You must start the process within 120 calendar days of the date on the bill.
Contact: visit www.cms.gov/nosurprises or call the U.S. Department of Health and Human Services (HHS) at 1-800-985-3059