February 1, 2015

February 1, 2015

To: Mitiukhliaeva Anna

Passport No.: 726904176 D.O.B. 18/07/2006

Price Quotation

The estimated price of Spinal Cord Posterior Nerve Root Rhysotomy surgery that will be performed by Dr. Ashkenazy is as follows:

https://vk.com/ann_veronika

Services	Price USD
Hospital fee - including up to 2 nights hospitalization in private room + up to 3 ICU, operating room, surgeon fee, monitoring, 31,459.00 blood tests before surgery.
VAT	0.00
Total USD	31,459.00

The price does not include:

- V.A.T (Inpatient tourist are free of VAT - up to 3 months in Israel)

- Private Nurse

- Private Anesthetist

Implants

- Frozen Section pathology tests (637.00 USD ea.)

- Pathology tests (230.00 USD ea.)

- Examination during the hospitalization, laboratory tests, MRI/CT/PET CT

Remarks:

Ø Price quotation corresponds with your inquiry as described to Assuta representative. Should the procedure will be different, price will be changed accordingly.

Ø Accurate price quotation may be provided only after consulting with the surgeon.

Ø Should the need arise for additional hour operating room; the cost per each hour will be 1,735.00 USD.

Ø Should the need arise for additional nights of hospitalization; the cost per each extra night will be 723.00 USD / The cost pet extra night in ICU 1,792.00 USD ea.

Ø Validity: February, 2015.

Sincerely Yours,

International Department

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