ORTHOPEDIC PROCEDURES- PROFESSIONAL FEES ONLY Description of Procedure Price ARTHROSCOPY, SHOULDER, GLENOHUMERAL JT $ 4,152 CLAVICULAR FX, ORIF $ 2,054 BIOPSY, SOFT TISSUE, UPPER ARM/ELBOW $ 1,155 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW $ 1,099 DEBRIDEMENT MUSCLE FASCIA < 20 SQ CM $ 444 REINSERTION, RUPTURED BICEPS/TRICPS TEND $ 2,207 REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW $ 1,917 DEBRIDE LAT/MED ELBOW $ 1,494 TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN WITH TENDON REPAIR OR REATTACHMENT $ 1,785 DEBRIDEMENT BONE MUSCLE/FASCIA <20 SQCM $ 659 INCISION, EXTENSOR TENDON SHEATH, WRIS $ 912 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST $ 1,545 DEBRIDEMENT BONE EA ADDL 20 SQCM $ 285 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR $ 1,502 CARPECTOMY; ALL BONES OF PROXIMAL ROW $ 1,668 REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA $ 2,170 ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CPM $ 2,237 INCISIONAL BIOPSY OF SKIN (EG, WEDGE) $ 163 OPEN TRMT OF DISTAL RADIAL FX $ 2,102 ORIF DISTAL RADIOUS INTRA-ARTICULAR $ 2,347 TENDON SHEATH INCISION; FINGERS/HAND $ 874 REPAIR EXTENSOR TENDON WO GRAFT $ 1,597 TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL $ 1,988 PERCUTANEOUS SKELETAL FIX UNSTABLE PHALANGE $ 1,333 OPEN TX PHALANGEAL FX $ 1,710 AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY $ 1,710 HIP ARTHROPLASTY $ 3,884 REVISION, TOTAL HIP $ 5,490 REVISION, THA, ACETABULUM $ 4,219 REVISON, THA, FEMUR $ 4,383 UNSPECIFIED PROCEDURE ON HIP $ 2,673 ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR FB REMOVAL $ 1,977 SUTURE OF INFRAPATELLAR TENDON; PRIMARY $ 1,614 MEDIAL COLLATERAL LIGAMENT REPAIR $ 1,921 RECONSTRUCTION JT DISLOCATE PATELLA $ 2,126 LATERAL RETINACULAR RELEASE $ 1,282 ARTHROPLASTY, PATELLA; WITH PROSTHESIS $ 2,332 ARTHROPLASTY, PARTIAL KNEE $ 3,316 TOTAL KNEE ARTHROPLASTY $ 3,824 REVISION OF TKA $ 4,024 REVISION TKA; FEMORAL/ENTIRE TIBIAL CMPT $ 5,025 REMOVAL OF PROSTHESIS $ 3,439 ORIF PATELLA FX $ 2,145 OPEN TREATMENT INTERCONDYLAR SPINES OF TIBIA W/INTERNAL FIXATION $ 2,244 MANIPULATION KNEE JT GEN ANESTHESIA $ 431 UNLISTED PROCEDURE, FEMUR OR KNEE $ 876 REPAIR, RUPTURED ACHILLES TENDON $ 1,827 REPAIR FLEXOR TENDON WO GRFT $ 1,061 REPAIR, SECONDARY, LIGAMENT, ANKLE, COLL $ 1,822 REMOVAL ANKLE IMPLANT $ 1,639 OPEN TX MEDIAL MALLEOLUS FX W/INTERNAL FIXATION $ 1,688 OPEN TX DISTAL FIB FX $ 1,534 OPEN TX, BIMALLEOLAR FX W/INTERNAL FIX $ 2,202 OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE $ 2,322 OPEN TX DISTAL TIB/FIB JT $ 1,955 OSTECTOMY, CALCANEUS $ 1,152 BONE EXCISION, PARTIAL;TALUS/CALC $ 1,409 REPAIR, TENDON, FLEXOR FOOT $ 898 TENOTOMY LENGTH/ABD HALLUCIS $ 817 CORRECTION, HALLUS VALGUS $ 1,483 OSTEOTOMY 1ST METAR (BUNIONECTOMY) $ 1,140 AMPUTATION, METATARSAL,W/TOE, SGL $ 1,235 AMPUTATION, MTP JOINT $ 1,130 ARTHROSCOPY, SHOULDER $ 1,346 ARTHROSCOPY, SHOULDER: CAPSULORRHAPHY $ 3,051 ARTHROSCOPY, SHOULDER: RPR SLAP LESION $ 2,978 SURGICAL REMOVAL OF LOOSE FB $ 1,681 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE $ 1,719 ARTHROSCOPY, SHOULDER, DISTAL CLAVICULEC $ 1,913 ARTHROSCOPY, SHOULDER W/LIG RELEASE $ 499 ARTHROSCOPY SHLDR ROTATOR CUFF REPAIR $ 2,482 ARTHROSCOPY, SHOULDER, BICEPS TENODESIS $ 2,620 ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE $ 1,589 ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE $ 1,349 ENDOSCOPY, WRIST, SURGICAL, W/RELEASE TRANSVERSE CARPAL LIGAMENT $ 1,381 ARTHROSCOPICALLY AIDED TRMNT, TIBIAL FX $ 2,235 ARTHROSCOPY, KNEE W/WO SYNOVIAL BX $ 1,175 ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE $ 1,435 ARTHROSCOPY, KNEE W/LATERAL RELEASE $ 1,463 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED $ 1,339 KNEE ARTHROSCOPY, SYNOVECTOMY 2+ COMPART $ 1,888 KNEE ARTHROSCOPY DEBRIDEMENT/SHAVING $ 1,784 ARTHROSCOPY, KNEE MENISCECTOMY $ 1,613 KNEE ARTHROSCOPY, W/MENISCECTOMY $ 1,554 ARTHROSCOPY, KNEE W/MENISCUS RPR $ 2,013 RECONSTRUCTION ANT CRUC LIGAMENT $ 2,822 UNLISTED PROCEDURE, ARTHROSCOPY $ 1,545 REMOVAL OF IMPLANT; SUPERFICIAL $ 1,068 REMOVAL, IMPLANT, DEEP $ 1,211 CPTR ASST SURG NAV $ 424 TENODESIS, LONG TENDON BICEPS $ 2,125 ARTHROPLASTY, TOTAL HIP, BILATERAL $ 7,768 TOTAL KNEE ARTHROPLASTY, BILATERAL $ 7,828 REVISION OF TOTAL KNEE ARTHROPLASTY, BILATERAL $ 10,051 CARPAL TUNNEL RELEASE, BILATERAL $ 2,424 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, $ 1,354 NEUROPLASTY, ULNAR NERVE, ELBOW $ 1,700 CARPAL TUNNEL RELEASE; MEDIAN NERVE $ 1,211 EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL $ 1,239 ARTHROCENTESIS/ASPIRATION/INJ, MAJOR JT, INPATIENT PROCEDURE $ 184 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED $ 1,535 CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACH JOINT $ 1,713 TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER, EACH TENDON $ 1,520 REPAIR, NONUNION OR MALUNION, FEMUR, $ 3,417 OPEN TREATMENT OF FRACTURE OF DISTAL TIBIA $ 2,276 OPEN TREATMENT OF KNEE DISLOCATION $ 2,823 ARTHROSCOPY, WRIST, SURGICAL $ 1,405 OSTEOPLASTY, RADIUS OR ULNA $ 2,076 ARTHRODESIS, WRIST; $ 2,343 REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL $ 1,741 EXCISION OF TENDON, FOREARM AND/OR WRIST $ 1,451 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST $ 826 CARPECTOMY; 1 BONE $ 1,285 CLAVICULECTOMY; PARTIAL $ 1,533 REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA $ 2,715 FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY $ 1,613 ENDOSCOPY, WRIST, BILATERAL, W/RELEASE TRANSVERSE CARPAL LIGAMENT $ 2,762 REMOVAL NON-BIODEGRADABLE DRUG IMPLANT $ 369 AVULSION NAIL PLATE PERM $ 484 OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END $ 3,126 EXCISION, OLECRANON BURSA $ 929 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE $ 508 OSTEOTOMY, RADIUS; DISTAL THIRD $ 1,769 ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FB $ 1,408 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE $ 903 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY; LUMBAR, SINGLE VERTEBRAL SEGMENT $ 2,875

ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, LUMBAR, SINGLE LEVEL $ 4,145 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, EA ADD'L SEGMENT $ 1,020 AUTOGRAFT FOR SPINE SURGERY ONLY $ 400 POSTERIOR SEGMENTAL INSTRUMENTATION $ 1,988 ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL $ 275 POSTERIOR NON-SEGMENTAL INSTRUMENTATION $ 1,980 REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION $ 1,830 SECONDARY CLOSURE OF SURGICAL WOUND, EXTENSIVE $ 2,083 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL $ 1,405 ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION $ 1,314 SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE $ 1,546 RADICAL RESECTION OF TUMOR, DISTAL PHALANX OF FINGER $ 1,652 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE, <20 SQ CM $ 2,073 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR $ 2,201 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR $ 2,004 PARTIAL EXCISION, BONE, TARSAL/METATARSAL $ 819 INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BON $ 1,512 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS $ 1,975 ARTHRODESIS, ANTERIOR INTERBODY, CERV; EA ADD'L LEVEL $ 1,035 OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FX $ 2,746 ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY $ 288 ARTHRODESIS, ANTERIOR INTERBODY, CERVICAL $ 4,439 INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) $ 674 ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENT $ 1,896 ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL; SINGLE; LUMBAR $ 4,828 OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL AP; 1 SEGMENT, LUMBAR $ 3,919 ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL; EA ADD'L SPACE $ 1,292 OSTEOTOMY OF SPINE, POSTERIOR OR POSTEROLATERAL AP; EA ADD'L SEGMENT $ 948 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY; EA ADD'L SEGMENT; C,T,L $ 549