In-Network / Out-of-Network Cost Comparison Calculator™
Please answer the following questions in order to help us calculate
the difference
between your in/out of network benefits.
(These are estimates and may vary depending on insurance and other circumstances.)
Note: If you are unsure of your plan's benefits, allow us to assist — call us at 203-325-2455.
Length of Stay: Please refer to the list of injuries below to get an estimate of the number of visits you will need for your injury.
Please note these are estimates and may vary depending on insurance and other circumstances.
Neck
1) Strain/Sprain…12
2) DJD (degerative Joint
Disease)…………...12
3) Disc Herniation……18
4) Disc Degeneration…12
5) Surgery: Fusion…18
6) Surgery: Discectomy…18
Shoulder
1) Tendonitis/Bursitis…………16
2) Impingement………………..18
3) Rotator Cuff
Strain/Sprain…………..12
4) Labral Tear……………18
5) Frozen Shoulder……….24
6) Proximal Humerus fracture…30
7) Surgery: Rotator Cuff…36
8) Surgery SLAP tear…….30
9) Surgery Decompression….18
Elbow
1) Lateral/Medial Epicondylitis…18
2) Surgery: Epicondylitis
release…12
3) Surgery: Bicep
tendon repair….12
Wrist/Hand
1) Wrist Sprain/Strain….12
2) Carpal Tunnel Syndrome…12
3) Surgery: Wrist fracture…18
4) Surgery: Hand/finger…20
Low Back
1) Herniated Disc……18
2) Sprain/Strain….12
3) Lumbar Radiculopathy/
Radiculitis…12
4) Spondylosis
(deg joint disease)…...12
5) Degenerative
Disc Disease…..12
6) Surgery: Laminectomy……..12
7) Surgery: Discectomy……….12
8) Surgery: Fusion…………….24
Hip
1) ITB Syndrome 18
2) Osteoarthritis………16
3) Bursitis………16
4) Surgery: Total Hip
Replacement…18
5) Surgery: Femur fracture….30
6) Surgery: Labral repair……24
Knee
1) Patellar Tendonitis/Bursitis…12
2) Pes Anserine Bursitis…12
3) Chondromalacia…12
4) Strains/Sprains…12
5) Osteoarthritis…12
6) Surgery: Meniscectomy…12
7) Surgery: ACL Repair…36
8) Surgery: Meniscus Repair…36
9) Surgery: Total Knee
Replacement…36
10) Surgery: Tibial Plateu
fx/repair…36
Ankle/Foot
1) Sprain/Strain….12
2) Plantar fasciitis….18
3) Achilles Tendonitis….18
4) Surgery: Achilles Repair…30
5) Surgery: Bunyonectomy…24
Example of how CO-INSURANCE works:
John Doe comes in for physical therapy. John visit cost $125.00. John has a deductible of $500, which he has already met. Once his deductible is met, his plan calls for an 80/20 split. His insurance pays 80% and John pays 20% based on the amount insurance allows. He has a 20% co-insurance.
Example of how CO-PAY works:
John takes his son, Billy, to physical therapy for a sprained ankle. If John goes in-network, his plan calls for a $30 co-pay for each physical therapy visit.
Example of how a DEDUCTIBLE works:
Sara falls off her bike and is rushed to the hospital by ambulance. The ambulance service is subject to her annual deductible of $250. Sara has not paid anything towards her deductible, so she is responsible for the first $250 of the $600 cost. She also is responsible for paying 20% coinsurance of the remaining bill.
| Ambulance Services | $600 |
| Sara's deductible | $250 |
| Remaining bill | $350 |
| Sara pays 20% of the remaining bill | $ 70 |
| Health plan pays 80% of remaining bill | $280 |
| Sara's total cost* | $320 |
*($250 deductible +$70 co-insurance)
Because Sara has met her $250 deductible, she will only be responsible to pay the 20% of future medical costs for the rest of the year.
Proactive Health Professionals Enhancing Physical Performance |
Serving Fairfield County Connecticut |