Tulsa Bone and Joint Associates Services include: professional and technical components, post-op, surgeon(s), anesthesia, intraoperative fluoroscopy, facility fees, routine radiology exams during uncomplicated follow-up care no more than 90 days. CPT PROCEDURE FEE ORTHOPEDIC PROCEDURES 11730 Avulsion of nail plate, partial or complete, simple; single $2,530.00 11740 Evacuation of subungual hematoma. $2,530.00 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for 11750 permanent removal $2,530.00 Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) 11755 (separate procedure). $2,530.00 11760 Repair of nail bed. $2,530.00 20680 Removal of Hardware, Deep - Simple (Pin, Ankle, Wrist) $2,530.00 20680 Removal of Hardware, Deep - Complex (Hip, Shoulder, Clavicle, large bone) $4,510.00 22551 Anterior Cervical Discectomy - 1 level (includes implants) $18,960.00 22552 Anterior Cervical Discectomy - 2+ levels (includes implants) $25,360.00 23120 Claviculectomy - partial / open (use 29824 for arthroscopic) $4,730.00 23410 Repair rotator cuff acute - open $6,150.00 23412 Repair rotator cuff chronic - open $6,150.00 23415 Release of shoulder ligament w/wo acromioplasty - open $6,150.00 23420 Reconstruction of complete shoulder cuff auvlsion w/ acromioplasty - open $6,150.00 23430 Biceps Tenodesis - open $4,950.00 23455 Bankhart w/ labral repair - open $6,150.00 23462 Capsulorrhaphy, anterior w coracoid transfer - open $6,150.00 25000 Incision, extensor tendon sheath - DeQuervains $2,950.00 25111 Excision of ganglion cyst - dorsal or palmar, primary $2,750.00 25447 Arthroplasty, interposition, intercarpal or carpometacarpal joints $4,600.00 25545 ORIF ulnar shaft fx $4,350.00 25606 Closed Reduction Wrist/Forearm ONLY -no possition pins $1,950.00 26055 Tendon sheath incision (trigger finger) $2,750.00 26145 Synovectomy, tendon sheath, radical tenosynovectomy, flexor tendon, palm … $2,950.00 26160 Excision of lesion of tendon sheath or joint capsule - cyst, ganglion - hand or finger $2,750.00 27096 SI jt injection $900.00 27340 Excision Pre-patellar bursa $4,510.00 27405 Repair primary torn ligament and/or capsule, knee, collateral - open $6,160.00 27420 Reconstruction of dislocating patella (Hauser type) $6,160.00 Open Treatment of Patellar Fracture, with Internal Fixation and/or Partial or Complete 27524 Patellectomy and Soft Tissue Repair (Implants paid separatly at cost) $4,510.00 27570 Manipulation Knee Under Anesthesia $2,530.00 27650 Ruptured achilles repair, primary, open or percutaneous $5,730.00 27680 Tenolysis, flexor extensor tendon, leg and/or ankle, single $2,475.00 27687 Gastrocnemius Resection $4,180.00 27695 Ligament Repair, Brostrom ($4,950.00 plus Implants $400.00) $5,350.00 27698 Watson Jones Repair ankle (repair, secondary, disrupted ligament collateral) $4,950.00 27870 Arthrodesis ankle - open $7,900.00 28035 Release Tarsal Tunnel $4,125.00 28285 Correction, hammertoe (interphalangeal fusion, partial or total phalangectomy) $2,475.00 - $3,335.00 28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first $4,125.00 28290 Correction, hallux valgus w/ wo sesamoidectomy (silver type) $4,125.00 28292 Correction hallux valgus w/ wo sesamoidectomy (Keller, McBride or Mayo) $4,125.00 28293 Correction hallux valgus w/ wo sesamoidectomy w/ implant $4,125.00 28296 Correction hallux valgus w/ wo ses.. w/ metatarsal osteotomy (Mitchell, Chevron) $4,125.00 28297 Correction hallux valgus w/ wo ses.. Lapidus-type $4,125.00 28298 Correction hallux valgus w/ wo ses .. Phalanx osteotomy $4,125.00 *This list of procedures are for review purposes only and is not a guarantee of benefits. Please refer to your Summary Plan Description. 29806 Arthroscopy, shoulder, capsulorrhaphy - surgical $5,750.00 29807 Arthroscopy, shoulder, repair of SLAP lesion $5,750.00 29819 Arthroscopy, shoulder, removal of loose body / foreign body $4,500.00 29820 Arthroscopy, shoulder, synovectomy, partial $4,500.00 29821 Arthroscopy, shoulder, synovectomy, complete $4,500.00 29822 Arthroscopy, shoulder, debridement, limited $4,500.00 29823 Arthroscopy, shoulder, debridement, extensive $5,750.00 29824 Arthroscopy, shoulder, distal claviculectomy including distal articular surface $5,750.00 29825 Arthroscopy, shoulder, with lysis and resection of adhesions, w/ wo manip $5,750.00 29826 Arthroscopy, shoulder, surgical decompression, partial acromioplasty $5,750.00 29827 Arthroscopy, shoulder, with rotator cuff repair $8,260.00 29828 Arthroscopy, shoulder, biceps tenodesis $6,160.00 29830 Arthroscopy, elbow diagnostic w/o synovial bx $3,750.00 29840 Arthroscopy, wrist, diagnostic w/o synovial bx $4,300.00 29848 Endoscopy, wrist, CTR (open use 64721) $4,300.00 29850 Arthroscopic treatment of fractures of knee wo ORIF includes arthroscopy $3,750.00 29851 Arthroscopically aided treatment of fx of knee w/ ORIF includes arthroscopy $3,750.00 29860 Arthroscopy, hip, diagnostic $5,575.00 29861 Arthroscopy, hip, with removal of loose body / FB $5,575.00 29862 Arthroscopy, hip, with debridement, chondroplasty or resection of labrum $5,575.00 29863 Arthroscopy, hip, surgical w/ synovectomy $5,575.00 29866 Arthroscopic osteochondral autograft $4,300.00 29870 Arthroscopy, knee w or w/o synovial bx $3,740.00 29871 Arthroscopy, knee for I&D $3,740.00 29871-50 Arthroscopy, knee bilateral $5,500.00 29873 Arthroscopy, knee w/ lateral release $4,510.00 29874 Arthroscopy, knee for removal of loose body, FB or OCD lesion $4,510.00 29875 Arthroscopy, knee w/ synovectomy - plica or shelf resection $4,510.00 29876 Arthroscopy, knee, w/ synovectomy - 2+ compartments $4,510.00 29877 Arthroscopy, knee debridement / chondroplasty (use 29880 / 29881 if menis) $4,510.00 29879 Arthroscopy, knee abrasion arthroplasty / microfracture $4,510.00 29880 Arthroscopy, knee meniscectomy (medial and lateral) including chondroplasty $4,510.00 29881 Arthroscopy, knee meniscectomy (medial AND lateral) including chondroplasty $4,510.00 29882 Arthroscopy, knee w/ meniscus repair- medial OR lateral $4,510.00 29883 Arthroscopy, knee with meniscus repair - medial AND lateral (not transplant) $5,500.00 29884 Arthroscopy, knee with lysis of adhesions w/ wo manipulation $3,740.00 29885 Arthroscopy, knee dirlling for OCD with bone grafting w/ wo ORIF $4,510.00 29886 Arthroscopy, knee drilling for intact OCD lesion $4,510.00 29887 Arthroscopy, knee drilling for intact OCD lesion and ORIF $4,510.00 29888 Arthroscopy, knee ACL reconstruction $7,100.00 29889 Arthroscopy, knee PCL reconstruction $7,100.00 29891 Arthroscopy, ankle excision of OCD talus and/or tibia including drilling $3,740.00 29894 Arthroscopy ankle w removal of FB (tibiotalar and fibulotalar joints) $3,740.00 29895 Arthroscopy ankle synovectomy partial (tibiotalar and fibulotalar joints) $3,740.00 29897 Arthroscopy ankle surgical debridement limited (tibiotalar and fibulotalar joints) $3,740.00 29898 Arthroscopy ankle surgical debridement extensive (tibiotalar and fibulotalar joints) $3,740.00 29899 Arthroscopy ankle with ankle arthrodesis (tibiotalar and fibulotalar joints) $3,740.00 29914 Arthroscopy hip with femoroplasty (treatment of cam lesion) $5,700.00 29915 Arthroscopy hip with acetabuloplasty (treatment of pincer lesion) $5,700.00 29916 Arthroscopy hip with labral repair (do not code w 29915, 29862 or 29863) $5,700.00 62281 Injection / infusion of neurolytic substance epi, Cerv or Thor (alcohol, phenol) $1,100.00 62282 Injection / infusion of neurolytic substance epi, Cerv or Thor CAUDAL $1,100.00 62310 Inject Spine Cerv/Thoracic $1,100.00 62311 Inject Spine Lumbar/Sacral $700.00 63005 Lumbar laminectomy 1-2 levels $9,900.00 63030 Lumbar Laminotomy 1 interspace $8,855.00 63047 Lumbar Laminectomy w decompression $9,900.00 64415 Brachial plexus block $800.00 64417 Axillary nerve lock $600.00 *This list of procedures are for review purposes only and is not a guarantee of benefits. Please refer to your Summary Plan Description. 64447 Femoral nerve block $800.00 64479 Inject Foramen Epidural C/T $700.00 64480 Inject Foramen Epidural C/T add on level $400.00 64483 Inject Foramen Epidural L/S $600.00 64484 Inject Foramen Epidural L/S add on level $300.00 64510 N Block Stellate Ganglion $1,100.00 64520 N Block Lumbar/Thoracic $1,100.00 64721 Carpal tunnel surgery $2,750.00 64831 Neurorrhaphy - suture of digital nerve hand or foot - one nerve $3,900.00 MRI 70551 MRI, brain (including brain stem); without contrast $600.00 70552 MRI, brain (including brain stem); with contrast $700.00 70553 MRI, brain (including brain stem); without and with contrast $650.00 71550 MRI, chest; without contrast $600.00 71551 MRI, chest; with contrast $700.00 71552 MRI, chest; without and with contrast $650.00 72141 MRI, spinal canal and contents, cervical; without contrast $600.00 72142 MRI, spinal canal and contents, cervical; with contrast $700.00 72146 MRI, spinal canal and contents, thoracic; without contrast $600.00 72147 MRI, spinal canal and contents, thoracic; with contrast $700.00 72148 MRI, spinal canal and contents, lumbar; without contrast $600.00 72149 MRI, spinal canal and contents, lumbar; with contrast $700.00 72156 MRI, spinal canal and contents, without and with contrast; cervical $650.00 72157 MRI, spinal canal and contents, without and with contrast; thoracic $650.00 72158 MRI, spinal canal and contents, without and with contrast; lumbar $650.00 72195 MRI, pelvis; without contrast $600.00 72196 MRI, pelvis; with contrast $700.00 72197 MRI, pelvis;