The Core Institute Specialty Hospital 6501 North 19th Avenue Phoenix, AZ 85015 602-795-6020 CPT Total Self Pay Code DRG Procedure Quote 22214 455 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment, lumbar $ 34,070.45 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment, each additional vertebral segment (List separately 22216 455 in addition to primary procedure) $ 34,458.52 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord 22551 473 and/or nerve roots cervical below C2 $ 20,154.92 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression) 22554 472 cervical below C2 $ 21,730.01 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression), 22558 460 lumbar $ 34,454.12 22612 460 Arthrodesis, posterior or posterolateral technique, single level, lumbar (with lateral transverse technique, when performed) $ 30,639.48 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for 22630 460 decompression), single interspace, lumbar $ 30,580.49 23120 483 Claviculectomy, partial $ 18,165.08 23395 483 Muscle transfer, any type, shoulder or upper arm, single $ 18,482.43 23412 483 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open, chronic $ 15,278.09 23430 483 Tenodesis of long tendon of biceps $ 16,429.44 23470 483 Arthroplasty, glenohumeral joint, hemiarthroplasty $ 17,861.29 23472 483 Arthroplasty, glenohumeral joint total shoulder (glenoid and proximal humeral replacement) $ 18,130.47 Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes 23615 483 repair of tuberosity(s), when performed $ 14,223.45 26476 469 Lengthening of tendon, extensor, hand or finger, each tendon $ 23,620.67 27130 470 Arthroplasty, Acetabular & Proximal Femoral Prosthetic Replacement (Total Hip) $ 16,047.58 27134 467 Revision of total hip arthroplasty, both components, with or without autograft or allograft $ 19,571.54 27138 468 Revision of total hip arthroplasty, femoral component only, with or without allograft $ 16,687.45 27280 460 Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performed $ 25,940.93 27422 488 Reconstruction of dislocating patella, with extensor realignment and/or muscle advancement or release $ 15,638.78 27438 467 Arthroplasty, patella, with prosthesis $ 16,177.17 27447 470 Arthroplasty, Knee, Condyle/Plateau Medial And Lateral Compartments $ 16,086.34 27486 468 Revision of total knee arthroplasty, with or without allograft, 1 component $ 18,949.03 27487 468 Revision of total knee arthroplasty, with or without allograft, femoral and entire tibial component $ 19,714.97 27625 497 Arthrotomy, with synovectomy, ankle $ 11,723.91 27635 494 Excision or curettage of bone cyst or benign tumor, tibia or fibula $ 14,472.91 27687 494 Gastrocnemius recession $ 23,432.86 27702 494 Arthroplasty, ankle, with implant $ 23,029.12 28725 505 Arthrodesis, subtalar $ 13,621.80 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or 63030 455 excision of herniated intervertebral disc 1 interspace, lumbar $ 14,726.96 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or 63040 455 excision of herniated intervertebral disc, reexploration, single interspace, cervical $ 11,213.17 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or 63045 455 nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment, cervical $ 13,803.42 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or 63047 455 nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment lumbar $ 11,367.81 Prices are subject to change without notice and are considered estimates. Please visit http://www.thecoreinstitutehospital.com/patients-visitors/billing-options/ or call 602-795-6020 for further information..