"* Your doctor's charge may be higher than the amount your health insurer will pay and, if so, you may be required to pay the difference; and
"* Your coinsurance, deductible and out-of-pocket maximum may be higher because your doctor is not in your health insurer's network.
"* An estimate of the cost of the services;
"* Any payment terms that apply; and
"* Whether your doctor will charge you interest on any unpaid balance, and the amount of the interest, if any.
Md. Code Regs. 31.10.41.06