HEALTH ONE ALLIANCE, LLC

FEE INFORMATION CONFIDENTIALITY STATEMENT

The enclosed fee schedule is provided out of courtesy and for your internal information only. It is not intended to be used to establish or revise any current fees of your practice. The Physician or Physicianís group, as-well-as any employees, affiliates, or agents, receiving this fee information may not, directly or indirectly, share or provide this information to any other venture, entity, or person not a part of Physicianís current practice. The acceptance of Physician or Physicianís group is evidenced to the right:

[close]