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ACL Repair

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ACL Repair

ACL Repair

ACL Repair in the ASC

$13,415.00

Patient Name

DOB (mm/dd/yyyy)

Direct Pay Service

I acknowledge this direct pay service will not be filed with my insurance and cannot be filed at a later date.

Refund

I will not be refunded if services are rendered. However, I acknowledge I will be refunded if my provider does not agree with the plan of care and services are not rendered.

Business Day Delay

If payment made after hours, on the weekend or holiday, your payment may not be posted to your account until the next business day. Please show your emailed receipt at your upcoming appointment.

Qty

Description

This includes everything the day of surgery (Surgeon, ASC, and Anesthesia). Physical Therapy and Postoperative visits are not included.

Additional Info

More Information
Benefits	No surprise bills for day of surgery.
FAQs	A visit is required prior to this service.
Brand	EmergeOrtho

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For patients needing ACL repair.

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Contact Us

120 William Penn Plaza
Durham, NC 27704

Phone: (919) 566-1400