Orthopaedics MSP billing codes


Professional Fees

Code Description Amount
51007 OFFICE VISIT - ORTHOPAEDICS $51.26
51008 HOSPITAL VISIT - ORTHOPAEDICS $30.70
51009 PAVLIC HARNESS-CASE MANAGEMENT $46.07
51010 CONSULTATION - ORTHOPAEDICS $109.99
51012 CONSULTATION - REPEAT/LIMITED - ORTHOPAEDICS $59.52
51015 CONSULTATION - SPECIAL - ORTHOPAEDICS $160.37

Professional Fees

Code Description Amount
51007 OFFICE VISIT - ORTHOPAEDICS $51.26
51008 HOSPITAL VISIT - ORTHOPAEDICS $30.70
51009 PAVLIC HARNESS-CASE MANAGEMENT $46.07
51010 CONSULTATION - ORTHOPAEDICS $109.99
51012 CONSULTATION - REPEAT/LIMITED - ORTHOPAEDICS $59.52
51015 CONSULTATION - SPECIAL - ORTHOPAEDICS $160.37

Surgical Assistant

Code Description Amount
00195 SURGICAL ASSIST-LESS THAN $317.00 INCLUSIVE $134.22
00196 SURGICAL ASSIST $317.01 TO 529.00 INCLUSIVE $189.24
00197 SURGICAL ASSISTANCE - OPERATIONS OVER $529.00 $260.35
00198 SURGICAL ASSIST TIME AFTER 3 HRS - PER 15 MINS $28.52
51194 FIRST SURGICAL ASSIST OF THE DAY-ORTHOPEDICS $76.71
70019 CERTIFIED SURGICAL ASSIST $256.63
70020 CERTIFIED SURGICAL ASSIST - TIME FROM 1-3 HOURS $32.23

Surgical Assistant

Code Description Amount
00195 SURGICAL ASSIST-LESS THAN $317.00 INCLUSIVE $134.22
00196 SURGICAL ASSIST $317.01 TO 529.00 INCLUSIVE $189.24
00197 SURGICAL ASSISTANCE - OPERATIONS OVER $529.00 $260.35
00198 SURGICAL ASSIST TIME AFTER 3 HRS - PER 15 MINS $28.52
51194 FIRST SURGICAL ASSIST OF THE DAY-ORTHOPEDICS $76.71
70019 CERTIFIED SURGICAL ASSIST $256.63
70020 CERTIFIED SURGICAL ASSIST - TIME FROM 1-3 HOURS $32.23

Application Of Cast (Incl. External Stimulator)

Code Description Amount
51016 CAST: SHORT ARM $23.33
51017 CAST - LONG ARM $23.23
51018 CAST - SHOULDER SPICA $86.95
51019 CAST - BELOW KNEE $23.23
51020 CAST - LONG LEG CYLINDER $23.23
51021 CAST - LONG LEG $23.23
51022 CAST - HIP SPICA - CHILD $86.95
51023 CAST - HIP SPICA - ADULT $86.95
51024 CAST - BODY $86.95
51025 CAST - CAST BRACE $46.49

Application Of Cast (Includes External Stimulator)

Code Description Amount
51016 CAST: SHORT ARM $23.33
51017 CAST - LONG ARM $23.23
51018 CAST - SHOULDER SPICA $86.95
51019 CAST - BELOW KNEE $23.23
51020 CAST - LONG LEG CYLINDER $23.23
51021 CAST - LONG LEG $23.23
51022 CAST - HIP SPICA - CHILD $86.95
51023 CAST - HIP SPICA - ADULT $86.95
51024 CAST - BODY $86.95
51025 CAST - CAST BRACE $46.49

Miscellaneous

Code Description Amount
51030 Orthopaedic interpretation and written report of submitted x-ray films - including CT scan and MRI $39.38
51035 SKELETAL TRACTION - APPLICATION $93.37
51036 COMPARTMENT PRESSURE MONITORING - EXTRA $92.97
51037 HARVESTING OF ILIAC CREST AUTOGRAFT - EXTRA $93.37
51038 HARVESTING OF SKIN GRAFT - EXTRA $102.68
51065 ILIZAROV INSTRUMENTATION, SIMPLE $1,092.35
51066 ILIZAROV INSTRUMENTATION; COMPLEX, MULTIPLE $1,498.46
51067 ILIZAROV INSTRUMENTATION EXTENSION/REVISION -FRAME $214.73

Miscellaneous Ortho

Code Description Amount
51030 Orthopaedic interpretation and written report of submitted x-ray films - including CT scan and MRI $39.38
51035 SKELETAL TRACTION - APPLICATION $93.37
51036 COMPARTMENT PRESSURE MONITORING - EXTRA $92.97
51037 HARVESTING OF ILIAC CREST AUTOGRAFT - EXTRA $93.37
51038 HARVESTING OF SKIN GRAFT - EXTRA $102.68
51065 ILIZAROV INSTRUMENTATION, SIMPLE $1,092.35
51066 ILIZAROV INSTRUMENTATION; COMPLEX, MULTIPLE $1,498.46
51067 ILIZAROV INSTRUMENTATION EXTENSION/REVISION -FRAME $214.73

Shoulder Girdle, Clavicle And Humerus

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
11200 ARTHROSCOPY- SHOULDER JOINT $298.77
11215 ARTHROTOMY - SHOULDER JOINT/BURSA $186.72
11230 BIOPSY - NEEDLE - SHOULDER JOINT/GA $186.72
11232 ARTHROSCOPY - BIOPSY- SHOULDER $242.74
11245 BIOPSY - OPEN $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
52210 Bursa, I and D, under GA $186.72
52215 Abscess, I and D, under GA $186.72
52220 Hematoma, drainage under GA, when sole procedure $242.74
52225 Shoulder joint arthrotomy, I and D $186.72
52250 SOFT TISSUE RELEASE - MUSCLE, TENDON $380.44
52255 Major release (shoulder contracture) $541.49
52305 EXCISION - ENDOSCOPIC - REMOVAL OF LOOSE BODY $287.62
52306 EXCISION - ENDOSCOPIC - Drilling osteochondral defect, with or without loose body $287.62
52307 PINNING - OSTEOCHONDRAL FRAGMENT $350.12
52310 DEBRIDEMENT, SYNOVECTOMY - TOTAL OR SUBTOTAL $410.88
52315 SHOULDER ABRASION $350.12
52320 LABRUM TEAR- EXCISION $242.74
52325 STABILIZATION PROCEDURE $569.50
52330 ACROMIOPLASTY - ENDOSCOPIC $410.88
52335 ARTHROSCOPIC CLAVICLE EXCISION-MEDIAL/LATERAL/EXTR $106.57
52355 EXCISION OF BURSA - SUBACROMIAL - OPEN $214.73
52356 ACROMIONECTOMY, ACROMIOPLASTY with or without resection of coraco-acromial ligament $350.12
52357 CLAVICLE EXCISION LATERAL/MEDIAL - OPEN $214.73
52360 ARTHROTOMY - SHOULDER: synovectomy, capsulectomy $406.12
52365 Benign soft tissue tumour (sub-fascial) $406.12
52370 BONE TUMOUR - BENIGN $406.12
52380 OSTEOMYELITIS - ACUTE, DECOMPRESSION $186.72
52385 OSTEOMYELITIS - DEBRIDEMENT WITH/WITHOUT RECONSTRUCTION $322.10
52405 INJECTION OF JOINT - SHOULDER/CLAVICLE/HUMERUS $11.63
52410 INJECTION - BURSA,TENDON SHEATH, OTHER PERI ARTICULAR STRUCTURES- SHOULDER/CLAVICLE $11.63
52415 INT FIXATION DEVICE(S) - REMOVAL - GA $242.15
52420 INT FIXATION DEVICE(S), REMOVAL - WITHOUT GA $70.02
52505 ROTATOR CUFF REPAIR - SIMPLE $434.15
52506 ROTATOR CUFF RECONSTRUCTION - COMPLEX $718.88
52515 STABILIZATION - ACROMIOCLAVICULAR JOINT - ACUTE $270.75
52516 STABILIZATION - ACROMIOCLAVICULAR JOINT - CHRONIC $406.12
52525 SHOULDER INSTABILITY - INFERIOR CAPSULAR SHIFT $569.50
52526 SHOULDER INSTABILITY -BANKART $630.18
52535 SHOULDER INSTABILITY-ANTERIOR REPAIRS $459.80
52540 SHOULDER INSTABILITY - POSTERIOR-GLENOID OSTEOTOMY $718.88
52541 SHOULDER INSTABILITY - POSTERIOR - SOFT TISSUE $597.51
52545 STABILIZATION - SHOULDER INSTABILITY -REVISION, $718.88
52550 TENDON REPAIR, PROXIMAL BICEPS, PECTORALIS MAJOR $434.15
52555 SHOULDER/CLAVICLE/HUMERUS TENDON TRANSFER $513.50
52601 PROXIMAL HUMERUS - REPAIR/REVISION $718.88
52602 CLAVICLE - REPAIR/REVISION $513.60
52603 HEMI-ARTHROPLASTY - SHOULDER $620.86
52604 SHOULDER PROSTHESIS - TOTAL $991.26
52605 SHOULDER PROSTHESIS - REMOVAL $462.14
52606 SHOULDER ARTHROPLASTY/HEMIARTHROPLASTY- TOTAL -REV $802.93
52607 SHOULDER ARTHROPLASTY - TOTAL - REVISION $1,335.36
52651 BONE GRAFTING - PROXIMAL HUMERUS $242.74
52652 BONE GRAFTING - CLAVICLE $149.38
52705 ORIF - CLAVICLE/ACROMION/CORACOID $436.58
52708 CLAVICLE/ACROMION/CORACOID - PRIMARY WOUND CARE $102.26
52709 CLAVICLE/ACROMION/CORACOID - SECONDARY WOUND MANAG $186.72
52710 STERNO-CLAVICULAR JOINT STABILIZATION $513.60
52715 SCAPULA - FRACTURE/DISLOCATION - ORIF $924.30
52718 SCAPULA - OPEN INJURY, PRIMARY WOUND CARE $102.26
52719 SCAPULA - OPEN INJURY, SECONDARY WOUND MANAGEMENT $186.72
52721 GLENOHUMERAL - CLOSED REDUCTION WITHOUT GA $93.37
52722 GLENOHUMERAL - CLOSED REDUCTION WITH GA $242.74
52725 GLENOHUMERAL - OPEN REDUCTION $406.12
52731 PROXIMAL HUMERUS - CLOSED REDUCTION WITH GA $186.72
52732 PROXIMAL HUMERUS-CLOSED RED. WITH GA TRACTION/PIN $186.72
52735 PROXIMAL HUMERUS - ORIF - TWO PART $541.49
52736 PROXIMAL HUMERUS - ORIF - THREE OR MORE PARTS $654.53
52737 PROXIMAL HUMERUS- HEMIPROSTHESIS/WIRING-FRACTURE $802.93
52738 PROXIMAL HUMERUS - OPEN INJURY-PRIMARY WOUND CARE $102.26
52739 PROXIMAL HUMERUS - OPEN INJURY -SECONDARY WOUND $186.72
52741 HUMERUS - SHAFT -CLOSED REDUCTION WITH GA $242.74
52742 HUMERUS - SHAFT-CLOSED REDUCTION-EXTERNAL FIXATION $354.78
52745 HUMERUS- SHAFT - ORIF/INTRAMEDULLARY NAILING $569.50
52748 HUMERUS - SHAFT - OPEN INJURY PRIMARY WOUND CARE $102.26
52749 HUMERUS - SHAFT-OPEN SECONDARY WOUND MANAGEMENT $186.72
52800 MANIPULATION UNDER GA - SHOULDER JOINT $93.97
52810 ARTHRODESIS - SHOULDER JOINT $952.30
52811 ARTHRODESIS - SCAPULA-THORACIC JOINT $746.91
52980 AMPUTATION - SHOULDER DISARTICULATION $774.90
52981 AMPUTATION - FOREQUARTER $924.30
52982 AMPUTATION - HUMERAL SHAFT $541.49
52998 AMPUTATION - PRIMARY WOUND CARE - OPEN INJURY $102.26
52999 AMPUTATION - SECONDARY WOUND MANAGEMENT - OPEN $186.72

Shoulder Girdle, Clavicle And Humerus

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
11200 ARTHROSCOPY- SHOULDER JOINT $298.77
11215 ARTHROTOMY - SHOULDER JOINT/BURSA $186.72
11230 BIOPSY - NEEDLE - SHOULDER JOINT/GA $186.72
11232 ARTHROSCOPY - BIOPSY- SHOULDER $242.74
11245 BIOPSY - OPEN $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
52210 Bursa, I and D, under GA $186.72
52215 Abscess, I and D, under GA $186.72
52220 Hematoma, drainage under GA, when sole procedure $242.74
52225 Shoulder joint arthrotomy, I and D $186.72
52250 SOFT TISSUE RELEASE - MUSCLE, TENDON $380.44
52255 Major release (shoulder contracture) $541.49
52305 EXCISION - ENDOSCOPIC - REMOVAL OF LOOSE BODY $287.62
52306 EXCISION - ENDOSCOPIC - Drilling osteochondral defect, with or without loose body $287.62
52307 PINNING - OSTEOCHONDRAL FRAGMENT $350.12
52310 DEBRIDEMENT, SYNOVECTOMY - TOTAL OR SUBTOTAL $410.88
52315 SHOULDER ABRASION $350.12
52320 LABRUM TEAR- EXCISION $242.74
52325 STABILIZATION PROCEDURE $569.50
52330 ACROMIOPLASTY - ENDOSCOPIC $410.88
52335 ARTHROSCOPIC CLAVICLE EXCISION-MEDIAL/LATERAL/EXTR $106.57
52355 EXCISION OF BURSA - SUBACROMIAL - OPEN $214.73
52356 ACROMIONECTOMY, ACROMIOPLASTY with or without resection of coraco-acromial ligament $350.12
52357 CLAVICLE EXCISION LATERAL/MEDIAL - OPEN $214.73
52360 ARTHROTOMY - SHOULDER: synovectomy, capsulectomy $406.12
52365 Benign soft tissue tumour (sub-fascial) $406.12
52370 BONE TUMOUR - BENIGN $406.12
52380 OSTEOMYELITIS - ACUTE, DECOMPRESSION $186.72
52385 OSTEOMYELITIS - DEBRIDEMENT WITH/WITHOUT RECONSTRUCTION $322.10
52405 INJECTION OF JOINT - SHOULDER/CLAVICLE/HUMERUS $11.63
52410 INJECTION - BURSA,TENDON SHEATH, OTHER PERI ARTICULAR STRUCTURES- SHOULDER/CLAVICLE $11.63
52415 INT FIXATION DEVICE(S) - REMOVAL - GA $242.15
52420 INT FIXATION DEVICE(S), REMOVAL - WITHOUT GA $70.02
52505 ROTATOR CUFF REPAIR - SIMPLE $434.15
52506 ROTATOR CUFF RECONSTRUCTION - COMPLEX $718.88
52515 STABILIZATION - ACROMIOCLAVICULAR JOINT - ACUTE $270.75
52516 STABILIZATION - ACROMIOCLAVICULAR JOINT - CHRONIC $406.12
52517 OPEN OR ARTHROSCOPIC SLAP/BICEPS TENODESIS REPAIR $630.18
52518 Open or arthroscopic SLAP/Biceps tenodesis repair and anterior or posterior glenohumeral stabilization and/or Bankart repair (isolated procedure) $914.94
52519 Open or arthroscopic SLAP/Biceps tenodesis or Bankart repair, and rotator cuff reconstruction, complex $1,033.99
52520 Open or arthroscopic SLAP/Biceps tenodesis repair, and Bankart repair including tendon transfer, and Rotator cuff repair $1,349.06
52521 Open or arthroscopic SLAP/Biceps tenodesis repair, and Bankart repair and tendon transfer, and Rotator cuff repair, and anterior glenohumeral stabilization and/or posterior glenohumeral stabilization $1,578.96
52525 SHOULDER INSTABILITY - INFERIOR CAPSULAR SHIFT $569.50
52526 SHOULDER INSTABILITY -BANKART $630.18
52535 SHOULDER INSTABILITY-ANTERIOR REPAIRS $459.80
52540 SHOULDER INSTABILITY - POSTERIOR-GLENOID OSTEOTOMY $718.88
52541 SHOULDER INSTABILITY - POSTERIOR - SOFT TISSUE $597.51
52545 STABILIZATION - SHOULDER INSTABILITY -REVISION, $718.88
52550 TENDON REPAIR, PROXIMAL BICEPS, PECTORALIS MAJOR $434.15
52555 SHOULDER/CLAVICLE/HUMERUS TENDON TRANSFER $513.50
52601 PROXIMAL HUMERUS - REPAIR/REVISION $718.88
52602 CLAVICLE - REPAIR/REVISION $513.60
52603 HEMI-ARTHROPLASTY - SHOULDER $620.86
52604 SHOULDER PROSTHESIS - TOTAL $991.26
52605 SHOULDER PROSTHESIS - REMOVAL $462.14
52606 SHOULDER ARTHROPLASTY/HEMIARTHROPLASTY- TOTAL -REV $802.93
52607 SHOULDER ARTHROPLASTY - TOTAL - REVISION $1,335.36
52651 BONE GRAFTING - PROXIMAL HUMERUS $242.74
52652 BONE GRAFTING - CLAVICLE $149.38
52705 ORIF - CLAVICLE/ACROMION/CORACOID $436.58
52708 CLAVICLE/ACROMION/CORACOID - PRIMARY WOUND CARE $102.26
52709 CLAVICLE/ACROMION/CORACOID - SECONDARY WOUND MANAG $186.72
52710 STERNO-CLAVICULAR JOINT STABILIZATION $513.60
52715 SCAPULA - FRACTURE/DISLOCATION - ORIF $924.30
52718 SCAPULA - OPEN INJURY, PRIMARY WOUND CARE $102.26
52719 SCAPULA - OPEN INJURY, SECONDARY WOUND MANAGEMENT $186.72
52721 GLENOHUMERAL - CLOSED REDUCTION WITHOUT GA $93.37
52722 GLENOHUMERAL - CLOSED REDUCTION WITH GA $242.74
52725 GLENOHUMERAL - OPEN REDUCTION $406.12
52731 PROXIMAL HUMERUS - CLOSED REDUCTION WITH GA $186.72
52732 PROXIMAL HUMERUS-CLOSED RED. WITH GA TRACTION/PIN $186.72
52735 PROXIMAL HUMERUS - ORIF - TWO PART $541.49
52736 PROXIMAL HUMERUS - ORIF - THREE OR MORE PARTS $654.53
52737 PROXIMAL HUMERUS- HEMIPROSTHESIS/WIRING-FRACTURE $802.93
52738 PROXIMAL HUMERUS - OPEN INJURY-PRIMARY WOUND CARE $102.26
52739 PROXIMAL HUMERUS - OPEN INJURY -SECONDARY WOUND $186.72
52741 HUMERUS - SHAFT -CLOSED REDUCTION WITH GA $242.74
52742 HUMERUS - SHAFT-CLOSED REDUCTION-EXTERNAL FIXATION $354.78
52745 HUMERUS- SHAFT - ORIF/INTRAMEDULLARY NAILING $569.50
52748 HUMERUS - SHAFT - OPEN INJURY PRIMARY WOUND CARE $102.26
52749 HUMERUS - SHAFT-OPEN SECONDARY WOUND MANAGEMENT $186.72
52800 MANIPULATION UNDER GA - SHOULDER JOINT $93.97
52810 ARTHRODESIS - SHOULDER JOINT $952.30
52811 ARTHRODESIS - SCAPULA-THORACIC JOINT $746.91
52980 AMPUTATION - SHOULDER DISARTICULATION $774.90
52981 AMPUTATION - FOREQUARTER $924.30
52982 AMPUTATION - HUMERAL SHAFT $541.49
52998 AMPUTATION - PRIMARY WOUND CARE - OPEN INJURY $102.26
52999 AMPUTATION - SECONDARY WOUND MANAGEMENT - OPEN $186.72

Elbow, Proximal Radius And Ulna

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
11300 ARTHROSCOPY - ELBOW JOINT $268.43
11302 ASPIRATION - BURSA/TENDON SHEATH - DIAGNOSTIC $23.23
11315 ARTHROTOMY - ELBOW JOINT $186.72
11330 BIOPSY - NEEDLE - ELBOW JOINT/GA $186.72
11332 ARTHROSCOPY/BIOPSY- ELBOW JOINT $296.44
11345 BIOPSY - OPEN - ELBOW JOINT $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
53210 ELBOW, PROXIMAL RADIUS/ULNA - I & D $186.72
53215 ELBOW, PROXIMAL RADIUS- ABSCESS I&D UNDER GA $186.72
53220 ELBOW, PROXIMAL RADIUS/ULNA - HEMATOMA UNDER GA $242.74
53225 ELBOW JOINT ARTHROTOMY I AND D $186.72
53250 ELBOW,PROXIMAL RADIUS/ULNA- DECOMPRESSION/NEUROLY $242.74
53255 ELBOW, INCISION-DECOMPRESSION,NEUROLYSIS $406.12
53260 ELBOW, FASCIOTOMY, COMPARTMENT SYNDROME $214.73
53269 ELBOW, INCISION - FASCIOTOMY, SECONDARY WOUND $186.72
53305 ELBOW, EXCISION -REMOVAL LOOSE BODY $333.85
53310 ELBOW, EXCISION - DEBRIDEMENT, SYNOVECTOMY-TOTAL $642.00
53355 ELBOW, EXCISION -THERAPEUTIC - BURSA/GANGLION $214.73
53360 ELBOW ARTHROTOMY - OPEN SYNOVECTOMY $406.12
53365 ELBOW EXCISION BENIGN SOFT TISSUE TUMOR,SUBFACIAL $270.75
53370 ELBOW - BONE TUMOUR, BENIGN $270.75
53380 BONE TUMOUR - ELBOW - OSTEOMYELITIS, ACUTE $186.72
53385 BONE TUMOUR - ELBOW - OSTEOMYELITIS-DEBRIDEMENT $322.10
53386 RADIAL HEAD RESECTION - ELBOW $242.74
53405 INJECTION OF JOINT - ELBOW $11.63
53410 INJECTION OF BURSA/TENDON SHEATH - ELBOW $11.63
53415 INT FIXATION DEVICE(S)-ELBOW-REMOVAL WITH GA $214.73
53420 INT FIXATION DEVICE(S)-ELBOW-REMOVAL/WITHOUT GA $70.02
53505 ELBOW INSTABILITY- CHRONIC $676.86
53510 RECURRENT DISLOCATION - RADIAL HEAD - ELBOW $569.50
53515 TRICEPS TENDON - ACUTE - ELBOW $352.44
53516 TRICEPS TENDON, FASCIAL RECONSTRUCTION - ELBOW $406.12
53520 BICEPS TENDON, LONGHEAD, TENODESIS - ELBOW $270.75
53521 BICEPS TENDON, DISTAL INSERTION - ELBOW $569.50
53530 TENDON TRANSFER - MAJOR - ELBOW $718.88
53531 TENDON TRANSFER- MINOR - ELBOW $434.15
53540 EPICONDYLITIS - FASCIAL STRIPPING - ELBOW $214.73
53601 HUMERAL SHAFT - REPAIR - ELBOW $711.89
53602 DISTAL HUMERUS - REPAIR - ELBOW $718.88
53603 RADIUS SHAFT -REPAIR - ELBOW $595.16
53604 ULNA SHAFT - REPAIR - ELBOW $520.94
53605 RADIUS AND ULNA SHAFTS - REPAIR/REVISION - ELBOW $718.88
53606 EPIPHYSIODESIS - REPAIR/REVISION - ELBOW $270.75
53607 PHYSEAL BAR EXCISION/HARVEST - ELBOW $448.14
53641 ARTHROPLASTY - ELBOW - INTERPOSITION/DISTRACTION $924.30
53642 ARTHROPLASTY- TOTAL ELBOW $991.26
53643 ARTHROPLASTY- TOTAL ELBOW - REVISION $1,335.36
53644 OSTEOCAPSULAR ARTHROPLASTY $924.49
53651 BONE GRAFTING: HUMERUS - ELBOW $242.74
53652 BONE GRAFTING - RADIUS AND/OR ULNA - ELBOW $242.74
53653 BONE GRAFTING - OLECRANON - ELBOW $149.38
53701 HUMERAL EPICONDYLE - Closed reduction, with GA, cast $242.74
53702 HUMERAL EPICONDYLE - Closed reduction percutaneous fixation $270.75
53705 HUMERAL EPICONDYLE - ORIF $270.75
53708 HUMERAL EPICONDYLE - Open injury, primary wound care $102.26
53709 HUMERAL EPICONDYLE - Open injury, secondary wound management $186.72
53711 DISTAL HUMERUS: Closed reduction, with GA, cast/traction $186.72
53712 DISTAL HUMERUS - Closed reduction external fixation/percutaneous fixation $386.07
53715 DISTAL HUMERUS - ORIF $444.88
53718 DISTAL HUMERUS - Open injury, primary wound care $102.26
53719 DISTAL HUMERUS - Open injury, secondary wound management $186.72
53721 DISTAL HUMERUS: Closed reduction, with GA, cast/traction/ and/or percutaneous fixation $186.72
53722 DISTAL HUMERUS-CLOSED REDUCTION EXTERNAL FIXATION $354.78
53725 DISTAL HUMERUS - ORIF - unicondylar/osteochondral $406.12
53726 DISTAL HUMERUS - ORIF - bicondylar with or without olecranon osteotomy $868.26
53727 DISTAL HUMERUS - Open Injury, primary wound care $102.26
53728 DISTAL HUMERUS - Open injury, secondary wound management $186.72
53735 OLECRANON - ORIF $416.76
53738 OLECRANON - Open injury, primary wound care $102.26
53739 OLECRANON - Open injury, secondary wound management $186.72
53741 RADIAL HEAD/NECK - Closed reduction, with GA, cast $242.74
53742 RADIAL HEAD/NECK - Closed reduction percutaneous fixation $270.75
53745 RADIAL HEAD/NECK - ORIF $406.12
53748 RADIAL HEAD/NECK - Open injury, primary wound care $102.26
53749 RADIAL HEAD/NECK - Open injury, secondary wound management $186.72
53751 ELBOW JOINT - Closed reduction, without GA $149.38
53752 ELBOW JOINT - Closed reduction, with GA $242.74
53755 ELBOW JOINT - OPEN REDUCTION $298.77
53761 RADIUS/ULNA SHAFT - Closed reduction, without GA, cast $93.37
53762 RADIUS/ULNA SHAFT- Closed reduction, with GA, cast $298.77
53765 RADIUS/ULNA SHAFT - ORIF $541.49
53768 RADIUS/ULNA SHAFT - Open injury, primary wound care $102.26
53769 RADIUS/ULNA SHAFT-Open injury, secondary wound management $186.72
53771 RADIUS OR ULNA SHAFT/MONTEGGIA-Closed reduction, with GA, cast $270.75
53772 RADIUS OR ULNA SHAFT/MONTEGGIA - Closed reduction external fixation $270.75
53775 RADIUS OR ULNA SHAFT/MONTEGGIA - ORIF $416.76
53778 RADIUS OR ULNA SHAFT/MONTEGGIA - Open injury, primary wound care $102.26
53779 RADIUS OR ULNA SHAFT/MONTEGGIA - Open injury, secondary wound management $186.72
53800 MANIPULATION - UNDER GA - ELBOW JOINT $93.37
53810 ARTHRODESIS - ELBOW JOINT $718.88
53980 AMPUTATION - ELBOW $406.12
53981 AMPUTATION - FOREARM $406.12
53998 AMPUTATION - FOREARM - PRIMARY WOUND CARE $102.26
53999 AMPUTATION - FOREARM - SECONDARY WOUND MANAGEMENT $186.72

Hand And Wrist

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
06218 AMPUTATION - TRANSMETACARPAL $254.92
06219 AMPUTATION - FINGER $254.92
07055 GANGLIA - WRIST $202.23
11400 ARTHROSCOPY - WRIST JOINT $287.62
11402 ASPIRATION - BURSA/SYNOVIAL SHEATH, ETC. $23.23
11415 ARTHROTOMY - WRIST JOINT - isolated procedure $186.72
11416 ARTHROTOMY - MP/PIP/DIP JOINTS $186.72
11430 BIOPSY - NEEDLE - WRIST JOINT/GA $186.72
11432 ARTHROSCOPY/BIOPSY - WRIST /HAND JOINT(S) $186.72
11445 BIOPSY - OPEN - HAND/WRIST $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
54305 REMOVAL OF LOOSE BODY - HAND/WRIST $242.74
54310 DEBRIDEMENT/ SYNOVECTOMY, TOTAL $324.44
54315 Excision triangular fibro cartilage complex (TFCC) $324.44
54350 FOREIGN BODY REMOVAL - HAND/WRIST/GA $214.73
54351 EXCISION - OPEN - MENISCUS/RADIOCARPAL $324.44
54372 BONE TUMOR - BENIGN - CARPALS/DISTAL RADIUS $324.44
54380 OSTEOMYELITIS, ACUTE - CARPALS, DISTAL/RADIUS $186.72
54385 OSTEOMYELITIS/DEBRIDEMENT - CARPALS/DISTAL RADIUS $322.10
54386 STYLOID - RADIAL/ULNAR - EXCISION $214.73
54387 CARPECTOMY - PROXIMAL ROW $541.49
54405 INJECTION JOINT $23.23
54410 Injection bursa, tendon sheath, other peri articular structures $23.23
54415 Removal of internal fixation device(s), with GA $214.73
54420 Removal of internal fixation device(s), without GA $46.68
54505 CARPAL INSTABILITY - ACUTE $597.51
54510 CARPAL INSTABILITY: CHRONIC $658.20
54515 DISTAL RADIO-ULNAR INSTABILITY - CHRONIC $487.81
54601 OSTEOTOMY - DISTAL RADIUS $658.20
54602 OSTEOTOMY - DISTAL ULNA $326.77
54603 CARPAL BONE (SCAPHOID) - REPAIR/REVISION $541.19
54604 OSTEOTOMY - EPIPHYSIODESIS/EPIPHYSIOPLASTY/RADIUS/ $496.12
54631 ARTHROPLASTY - ULNA - DISTAL EXCISION $242.74
54632 JOINT REPLACEMENT - TOTAL WRIST $718.88
54633 ARTHROPLASTY- SILASTIC WRIST $541.49
54634 WRIST PROSTHESIS - REMOVAL $270.75
54635 ARTHROPLASTY - TOTAL WRIST - REVISION $952.30
54651 BONE GRAFTING - DISTAL RADIUS/ULNA $242.74
54652 BONE GRAFTING - METACARPAL/PHALANX $121.36
54701 RADIUS - FRACTURE/DISLOCATION-CLOSED REDUCTION $252.09
54702 RADIUS - CLOSED REDUCTION/GA $298.77
54703 RADIUS - EXTERNAL/PERCUTANEOUS FIXATION. $326.77
54705 RADIUS - ORIF $518.18
54708 RADIUS - PRIMARY WOUND CARE $51.13
54709 RADIUS - SECONDARY WOUND MANAGEMENT $93.37
54715 CARPAL BONE FRACTURE(SCAPHOID) - OPEN REDUCTION $434.15
54721 CARPUS-DISLOCATION-W/WO FRACTURE-CLOSED REDUCTION $252.09
54722 CARPUS - CLOSED REDUCTION/PERCUTANEOUS FIXATION $298.77
54725 CARPUS - ORIF $597.51
54728 CARPUS - PRIMARY WOUND CARE $51.13
54729 CARPUS - SECONDARY WOUND MANAGEMENT $93.37
54800 MANIPULATION - HAND/WRIST JOINT UNDER GA $93.37
54810 ARTHRODESIS - WRIST - LIMITED OR TOTAL $658.20

Pelvis, Hip And Femur

Code Description Amount
11501 ASPIRATION - HIP JOINT $23.23
11502 ASPIRATION - HIP -BURSA/TENDON SHEATH, ETC. $11.63
11515 ARTHROTOMY - HIP JOINT $298.77
11530 BIOPSY - NEEDLE- HIP/GA $186.72
11532 ARTHROSCOPY/BIOPSY - HIP $518.18
11545 ARTHROTOMY/BIOPSY - HIP $242.74
11546 BIOPSY - HIP - SOFT TISSUE/BONE $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
55210 PELVIS/HIP/FEMUR- INCISION/DRAINAGE/GA $186.72
55215 ABSCESS - PELVIS/HIP/FEMUR -INCISION/DRAINAGE/GA $186.72
55220 HEMATOMA - PELVIS/HIP/FEMUR - DRAINAGE UNDER GA $298.77
55225 ARTHROTOMY - HIP JOINT - I AND D $322.10
55255 SOFT TISSUE RELEASE - HIP- PERCUTANEOUS $270.75
55270 MINOR RELEASE - HIP - ONE TENDON $298.77
55275 MAJOR RELEASE - TWO OR MORE - HIP $406.12
55305 LOOSE BODY - HIP - REMOVAL $378.11
55310 DEBRIDEMENT/SYNOVECTOMY - HIP - TOTAL $597.51
55355 EXCISION - OPEN - HIP - BURSA/TROCHANTERIC $214.73
55360 ARTHROTOMY - HIP - OPEN SYNOVECTOMY - TOTAL $569.50
55365 SOFT TISSUE TUMOUR - BENIGN -HIP - SUBFASCIAL $406.12
55370 BONE TUMOUR, BENIGN - HIP $434.15
55371 HETEROTOPIC BONE RESECTION $515.94
55380 OSTEOMYELITIS, ACUTE - HIP - DECOMPRESSION $186.72
55385 OSTEOMYELITIS, DEBRIDEMENT - HIP $322.10
55405 INJECTION OF JOINT - HIP $11.63
55410 INJECTION OF BURSA/TENDON SHEATH - HIP $11.63
55415 INT FIXATION DEVICE(S) - REMOVAL - HIP/GA $242.74
55420 INT FIXATION DEVICE(S) - REMOVAL - HIP/WITHOUT G $70.02
55505 SOFT TISSUE REPAIR - HIP INSTABILITY $653.54
55510 TENDON-MUSCLE TRANSFER - HIP $658.20
55515 TENDON AVULSION REPAIR - HIP $326.77
55601 OSTEOTOMY - PELVIS - ADULT $746.91
55602 OSTEOTOMY - PELVIS - PAEDIATRIC $597.51
55603 OSTEOTOMY - PROXIMAL FEMUR - ADULT $746.91
55604 OSTEOTOMY - PROXIMAL FEMUR - PAEDIATRIC $746.91
55605 OSTEOTOMY - FEMORAL SHAFT - ADULT $774.90
55606 OSTEOTOMY - FEMORAL SHAFT - PAEDIATRIC $774.90
55607 OSTEOTOMY - MULTIPLE FOR OSTEOGENESIS IMPERFECTA $891.61
55631 PELVIS: NON-UNION OR MALUNION $1,363.10
55632 NONUNION OR MALUNION - ACETABULUM $1,848.57
55633 NONUNION OR MALUNION - PROXIMAL FEMUR $896.29
55634 NONUNION OR MALUNION - SHAFT FEMUR $774.90
55635 NONUNION OR MALUNION - FEMORAL LENGTHENING, OPEN $896.29
55636 NONUNION OR MALUNION - FEMORAL SHORTENING, CLOSED $896.29
55651 BONE GRAFTING - FEMUR $270.75
55652 BONE GRAFTING - EPIPHYSIODESIS, GREATER TROCHANTER $326.77
55661 ARTHROPLASTY - RESECTION - HIP $490.15
55662 HEMI-ARTHROPLASTY - HIP $567.62
55663 TOTAL HIP PROSTHESIS $802.93
55671 REVISION TOTAL HIP ARTHROPLASTY: COMPONENTS $802.93
55672 TOTAL HIP ARTHROPLASTY- EXCHG OF MODULAR COMPONENT $434.15
55673 REVISION - FEMUR OR ACETABULUM $989.64
55674 REVISION - FEMUR AND ACETABULUM,INCLUDES PROSTALAC $1,307.07
55675 PROXIMAL FEMORAL REPLACEMENT $1,633.84
55701 FRACTURE-PELVIS-CLOSED REDUCTION-SKELETAL TRACTION $93.37
55702 PELVIS - CLOSED REDUCTION - EXTERNAL FIXATION $494.83
55705 PELVIS - EXTERNAL FIXATION/ORIF $1,092.35
55706 PELVIS -ORIF- ANTERIOR OR POSTERIOR $765.57
55707 PELVIS -ORIF - ANTERIOR AND POSTERIOR $1,171.69
55711 HIP - DISLOCATION - TRAUMATIC $93.37
55712 REDUCTION - HIP/GA $186.72
55715 REDUCTION - HIP - OPEN $490.15
55721 DISLOCATION- CONGENITAL- HIP- CLOSED REDUCTION/GA $270.75
55725 DISLOCATION - CONGENITAL - OPEN REDUCTION -HIP $714.22
55726 HIP DISLOC.OPEN REDUCTION FEM OR PELVIC OSTEOTOMY $1,047.97
55727 HIP DISLOC. OPEN REDUCTION FEM & PELVIC OSTEOTOMY $1,318.75
55731 HIP - FRACTURE/DISLOCATION - REDUCTION $93.97
55732 HIP - REDUCTION/GA $186.72
55735 HIP - OPEN REDUCTION $490.15
55736 HIP - ORIF $952.30
55738 HIP - PRIMARY WOUND CARE $102.26
55739 HIP - SECONDARY WOUND MANAGEMENT $186.72
55741 ACETABULUM - FRACTURE- CLOSED REDUCTION $186.72
55745 ACETABULUM - ORIF - ONE APPROACH $1,297.34
55746 ACETABULUM - TWO/EXTENSILE APPROACH $1,848.57
55751 FEMORAL NECK/SUBCAPITAL -FRACTURE-CLOSED REDUCTION $518.18
55755 FEMORAL NECK/SUBCAPITAL - ORIF $830.94
55758 FEMORAL NECK/SUBCAPITAL - PRIMARY WOUND CARE $102.26
55759 FRAC. FEMORAL NECK OR SUBCAPITAL: OPEN -SEC. WOUND $186.72
55760 FEMORAL NECK/SUBCAPITAL - SCFE INSITU FIXATION $518.18
55761 HIP - INTERTROCHANTERIC - REDUCTION $653.54
55768 HIP FRACTURE INTERTROCHANTERIC PRIMARY WOUND CARE $102.26
55769 HIP-INTERTROCHANTERIC - SECONDARY WOUND MANAGEMENT $186.72
55771 HIP: SUBTROCHANTERIC - INTERNAL FIXATION $891.61
55778 SUBTROCHANTERIC - PRIMARY WOUND CARE $102.26
55779 SUBTROCHANTERIC - SECONDARY WOUND MANAGEMENT $186.72
55780 FEMUR/SHAFT - CAST/TRACTION - CLOSED REDUCTION $121.36
55781 FEMUR/SHAFT - CLOSED REDUCTION/GA $214.73
55782 FEMUR/SHAFT - EXTERNAL SKELETAL FIXATION $354.78
55783 FEMUR/SHAFT - CLOSED REDUCTION, IM NAIL $774.90
55785 FEMUR/SHAFT - ORIF $774.90
55788 FEMUR/SHAFT - PRIMARY WOUND CARE $102.26
55789 FEMUR/SHAFT - SECONDARY WOUND MANAGEMENT $186.72
55800 MANIPULATION - HIP JOINT UNDER GA $93.37
55810 ARTHRODESIS - HIP JOINT $1,227.71
55980 AMPUTATION - HEMICORPECTOMY $2,446.08
55981 AMPUTATION - HEMIPELVECTOMY $1,363.10
55982 AMPUTATION - HIP DISARTICULATION $1,036.32
55983 AMPUTATION - ABOVE KNEE $653.54
55984 AMPUTATION - KNEE DISARTICULATION $653.54
55985 REVISION,AMPUTATION, BELOW KNEE $518.18
55998 Open injury, primary wound care $101.50
55999 AMPUTATION - SECONDARY WOUND MANAGEMENT-ABOVE KNEE $186.72

Femur, Knee Joint, Tibia And Fibula

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
11600 ARTHROSCOPY - KNEE JOINT $214.73
11602 ASPIRATION - KNEE JOINT - BURSA/TENDON SHEATH, E $23.23
11615 ARTHROTOMY - KNEE JOINT $242.74
11630 BIOPSY - NEEDLE - KNEE JOINT/GA $186.72
11632 ARTHROSCOPY/BIOPSY - KNEE JOINT $214.73
11645 BIOPSY - OPEN - KNEE JOINT $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
56210 FEMUR, KNEE JOINT/TIBIA/FIBULA - I & D/GA $186.72
56215 FEMUR/KNEE JOINT/TIBIA/FIBULA - ABSCESS I & D/GA $186.72
56220 HEMATOMA - FEMUR/KNEE JOINT/TIBIA/FIBULA $298.77
56225 ARTHROTOMY - KNEE JOINT $186.72
56250 DECOMPRESSION - KNEE JOINT $214.73
56260 FASCIOTOMY, COMPARTMENT SYNDROME - KNEE JOINT $235.21
56269 KNEE JOINT - SECONDARY WOUND CLOSURE $186.72
56270 SOFT TISSUE RELEASE - KNEE - MINOR $345.45
56275 SOFT TISSUE RELEASE - KNEE - MAJOR $487.81
56280 KNEE LIBERATION/MAJOR RELEASE $770.24
56285 QUADRICEPS PLASTY - KNEE $625.53
56290 RETINACULAR RELEASE - LATERAL/MEDIAL KNEE - OPEN $242.74
56305 REMOVAL SYMPTOMATIC LOOSE BODY - KNEE $287.62
56306 KNEE - PINNING/DRILLING OSTEOCHONDRAL FRAGMENT $410.88
56310 SYNOVECTOMY KNEE, TOTAL $487.92
56315 RESECTION 'PLICA' $287.62
56320 MENISECTOMY - KNEE $287.62
56321 ARTHROPLASTY - KNEE - ARTHROSCOPIC $287.62
56322 ABRASION DEBRIDEMENT, EXTRA - FIRST 15 MIN. $143.81
56323 ABRASION DEBRIDEMENT,EXTRA-EACH ADDITIONAL 15 MIN. $71.91
56325 MENISCAL REPAIR $410.88
56330 ABRASION/DEBRIDEMENT - KNEE $287.62
56335 LATERAL/MEDIAL RELEASE - ENDOSCOPIC KNEE $287.62
56353 GANGLION/CYST - KNEE $214.73
56354 POPLITEAL CYST - KNEE $298.77
56355 OPEN EXCISION - KNEE - BURSA/PREPATELLAR $214.73
56356 ARTHROTOMY - REMOVAL OF LOOSE BODY - KNEE $242.74
56357 ARTHROTOMY KNEE - PINNING/DRILLING $352.44
56360 SYNOVECTOMY - KNEE, TOTAL $464.48
56361 MENISECTOMY - KNEE $242.74
56362 MENISCAL REPAIR - KNEE $352.44
56365 SOFT TISSUE TUMOUR - BENIGN - KNEE $326.77
56370 BONE TUMOUR - BENIGN - KNEE $270.75
56380 OSTEOMYELITIS ACUTE - KNEE - DECOMPRESSION $186.72
56385 OSTEOMYELITIS/DEBRIDEMENT - KNEE. $214.73
56390 PATELLECTOMY $326.77
56405 INJECTION OF JOINT - KNEE $23.23
56410 INJECTION - BURSA/TENDON SHEATH - KNEE $23.23
56415 KNEE - REMOVAL OF INT FIXATION DEVICE(S)/GA $242.74
56420 KNEE - REMOVAL OF INTERNAL FIXATION DEVICE(S) $70.02
56505 KNEE LIGAMENT INSTABILITY - ONE REPAIR $616.34
56510 KNEE LIGAMENT INSTABILITY - POSTERIOR CRUCIATE $746.91
56515 KNEE LIGAMENT INSTABILITY - TWO LIGAMENTS $718.62
56520 KNEE LIGAMENT INSTABILITY - THREE LIGAMENTS $835.59
56525 REVISION OF KNEE LIGAMENT RECONSTRUCTION $718.88
56528 KNEE LIGAMENT - OPEN INJURY - PRIMARY WOUND CARE $102.26
56529 KNEE LIGAMENT - OPEN INJURY - SECONDARY WOUND CARE $186.72
56530 RECUR. SUBLUX./DISLOC. PATELLA-EXTENSOR REALIGNMEN $434.15
56531 RECURR. SUBLUX./DISLOC. PATELLA-LATERAL RELEASE $242.74
56540 RECURR. SUBLUX./DISLOC. QUAD. TENDON RUPTURE,ACUTE $345.45
56541 RECURR. SUBLUX./DISLOC. QUAD. TENDON RUPT.-CHRONIC $490.15
56542 PATELLAR TENDON REPAIR $480.90
56545 TENDON TRANSFER, TRANSPLANT - PATELLA $326.77
56601 OSTEOTOMY DISTAL FEMUR - NON-UNION/MALUNION $802.93
56602 OSTEOTOMY PROXIMAL TIBIA - NON-UNION/MALUNION $569.50
56603 OSTEOTOMY TIBIA/SHAFT/FIBULA - NON-UNION/MALUNION $746.91
56604 OSTEOTOMY FIBULA -NON-UNION/MALUNION $270.75
56651 FEMUR - BONE GRAFTING $270.75
56652 BONE GRAFTING - TIBIA $270.75
56653 BONE GRAFTING - EPIPHYSIODESIS $298.77
56654 BONE GRAFTING - PHYSEAL BAR EXCISION $508.83
56661 ARTHROPLASTY - KNEE JOINT $809.23
56662 TOTAL KNEE REPLACEMENT $802.93
56663 TOTAL KNEE, REMOVAL PROSTHESIS, INCLUDES PROSTALAC $490.15
56664 REVISION - TOTAL KNEE $1,104.00
56665 REVISION - PATELLAR COMPONENT $406.12
56701 FRAC./DISLOC. FEMUR (SUPRACOND) -CLOSED W/O GA $121.36
56702 FRAC./DISLOC. FEMUR (SUPRACOND) - CLOSED W/ GA $214.73
56703 FRAC./DISLOC. FEMUR (SUPRACOND)-CLOSED, EXTERN FIX $354.78
56704 FRAC./DISLOC. FEMUR (SUPRACOND)- CLOSED W/ IM NAIL $774.90
56705 FRAC./DISLOC. FEMUR (SUPRACONDYLAR) - ORIF $774.90
56708 FRAC./DISLOC. FEMUR (SUPRACOND)- PRIM. WOUND CARE $102.26
56709 FRAC./DISLOC. FEMUR (SUPRACOND)- SEC. WOUND CARE $186.72
56711 FRAC./DISLOC. FEMUR COND./INTRACOND-CLOSED W/O GA $93.37
56712 FRAC./DISLOC. FEMUR COND./INTRACOND.-CLOSED W/ GA $186.72
56713 FRAC./DISLOC. FEMUR COND/INTRACOND-CLOSED EX FIX $354.78
56715 FRAC/DISLOC FEMUR COND/INTRACOND-ORIF-UNICONDYLAR $774.90
56716 FRAC/DISLOC FEMUR COND/INTRACOND-ORIF-BICONDYLAR $1,115.69
56718 FRAC/DISLOC FEMUR CON/INTRACOND-OP PRIM WOUND CARE $102.26
56719 FRAC/DISLOC FEMUR COND/INTRACOND-OP SEC WOUND CARE $186.72
56725 PATELLAR DISLOCATION - OPEN REDUCTION & REPAIR $242.74
56728 PATELLAR DISLOCATION - OPEN - PRIMARY WOUND CARE $102.26
56729 PATELLAR DISLOCATION - OPEN -SEC. WOUND MANAGEMENT $186.72
56734 PATELLECTOMY - PATELLA FRACTURE $324.34
56735 PATELLAR FRACTURE - ORIF $462.14
56738 PATELLAR FRACTURE - OPEN - PRIMARY WOUND CARE $102.26
56739 PATELLAR FRACTURE - OPEN - SEC. WOUND MANAGEMENT $186.72
56741 TIBIAL PLATEAU FRACTURE - CLOSED RED. W/ GA $186.72
56742 TIBIAL PLATEAU FRACTURE - CLOSED RED, EXTERN FIX $382.78
56745 TIBIAL PLATEAU FRACTURE - ORIF - UNICONDYLAR $653.54
56746 TIBIAL PLATEAU FRACTURE - ORIF - BICONDYLAR $924.30
56748 TIBIAL PLATEAU FRACTURE - OPEN - PRIM. WOUND CARE $102.26
56749 TIBIAL PLATEAU FRACTURE - OPEN - SEC. WOUND MANAGE $186.72
56751 TIBIAL SHAFT FRACTURE - CLOSED RED. W/O GA $93.37
56752 TIBIAL SHAFT FRACTURE - CLOSED RED. W/ GA $214.73
56753 TIBIAL SHAFT FRACTURE - CLOSED RED. EXTERN FIX $354.78
56754 TIBIAL SHAFT FRACTURE - CLOSED REDUCTION IM NAIL $686.20
56755 TIBIAL SHAFT FRACTURES - ORIF $569.50
56758 TIBIAL SHAFT FRACTURE - OPEN - PRIM. WOUND CARE $102.26
56759 TIBIAL SHAFT FRACTURE - OPEN - SEC. WOUND MANAG. $186.72
56769 FIBULAR SHAFT FRACTURE - OPEN - PRIM. WOUND CARE $186.72
56800 MANIPULATION - KNEE JOINT W/ GA $93.37
56810 ARTHRODESIS - KNEE JOINT $802.93
56980 AMPUTATION - BELOW THE KNEE $518.18
56998 AMPUTATION: BELOW KNEE - OPEN - PRIM. WOUND CARE $102.26
56999 AMPUTATION: BELOW KNEE - OPEN - SEC. WOUND MANA $186.72

Tibial Metaphysis (Distal), Ankle And Foot

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
11700 ARTHROSCOPY - ANKLE /SUBTALAR JOINT $186.72
11702 ASPIRATION - ANKLE JOINT - BURSA/TENDON SHEATH, ET $23.23
11715 ANKLE JOINT - INCISION -DIAGNOSTIC $186.72
11716 SUBTALAR JOINT - INCISION - DIAGNOSTIC $186.72
11717 MIDTARSAL JOINT - INCISION - DIAGNOSTIC $186.72
11718 TARSO-METATAR/METATAR-PHALANG/INTERPHALANG JOINTS $186.72
11730 TIBIAL METAPHYSIS/ANKLE/FOOT - NEEDLE BIOPSY W/ GA $186.72
11745 TIBIAL METAPHYSIS/ANKLE/FOOT - OPEN BIOPSY W/ GA $242.74
05721 ASPIRATION - BURSA $23.23
51040 ASPIRATION - JOINT $23.23
57210 TIBIAL METAPHYSIS/ANKLE/FOOT: I&D BURSA W/ GA $186.72
57215 TIBIAL METAPHYSIS/ANKLE/FOOT - I&D ABSCESS W/ GA $186.72
57220 TIBIAL METAPHYSIS/ANKLE/FOOT-HEMATOMA DRAIN. W/ GA $298.77
57225 ANKLE/FOOT JOINT - I&D W/ GA $186.72
57250 TIBIAL METAPHYSIS/ANKLE/FOOT-DECOMP/NEUROLYS NERVE $298.77
57260 TIBIAL METAPHYSIS/ANKLE/FOOT- FACIOTOMY,COMPAR SYN $214.73
57269 TIBIAL METAPHYSIS/ANKLE/FOOT-FACIOTOMY,SEC CLOSURE $186.72
57270 PLANTAR FASCIA: OPEN RELEASE OR PARTIAL EXCISION $270.75
57275 PLANTAR FASCIECTOMY - TOTAL $406.12
57280 ACHILLES TENDON LENGTHENING, PERCUTANEOUS $214.73
57285 POSTERIOR HINDFOOT RELEASE $434.15
57286 POSTEROMEDIAL RELEASE (CLUB FOOT/VERTICAL TALUS) $718.88
57290 TIBIAL METAPHYSIS/ANKLE/FOOT -TENDON LENGTH.- OPEN $270.75
57295 TIBIAL METAPHYSIS/ANKLE/FOOT - TENOSYNOVECTOMY $270.75
57305 REMOVAL OF LOOSE BODY-TIBIAL METAPHYSIS/ANKLE/FOOT $287.62
57306 PINNING/DRILLING FRAGMENTS: TIBIAL/ANKLE FOOT $410.88
57310 SYNOVECTOMY - ANKLE, TOTAL $462.24
57330 ABRASION/DEBRIDEMENT- TIBIAL METAPHYSIS/ANKLE/FOOT $287.62
57354 GANGLION - TIBIAL METAPHYSIS/ANKLE/FOOT $214.73
57355 EXCISION BURSA - ACHILLES $214.73
57356 NEUROMA - TIBIAL METAPHYSIS/ANKLE/FOOT $214.73
57360 TOTAL SYNOVECTOMY-TIBIAL METAPHYSIS/ANKLE/FOOT $354.78
57365 BENIGN SOFT TISSUE TUMOUR - TIBIAL/ANKLE/FOOT $214.73
57370 BENIGN BONE TUMOUR - TIBIAL/ANKLE/FOOT $352.44
57371 TARSAL COALITION - ANKLE/FOOT $352.44
57372 SESAMOIDECTOMY - TIBIAL METAPHYSIS/ANKLE/FOOT $242.74
57373 ACCESSORY NAVICULAR - TIBIAL METAPHYSIS/ANKLE/FOOT $242.74
57374 TALECTOMY - TIBIAL METAPHYSIS/ANKLE/FOOT $541.49
57375 EXCISION - NAIL BED - ANKLE/FOOT/GA $214.73
57380 OSTEOMYELITIS, ACUTE- TIBIAL METAPHYSIS/ANKLE/FOOT $186.72
57385 OSTEOMYELITIS,DEBRIDEMENT- TIBIAL/ANKLE/FOOT $322.10
57405 INJECTION OF JOINT - TIBIAL METAPHYSIS/ANKLE/FOOT $11.63
57410 INJECTION OF BURSA - TIBIAL METAPHYSIS/ANKLE/FOOT $11.63
57415 REM. OF INT. FIX. DEV(S) - ANKLE/FOOT W/ GA $214.73
57420 REM. OF INT. FIX. DEV(S) - ANKLE/FOOT W/O GA $46.68
57505 ANKLE INSTABILITY: CAPSULE/LIGAMENT REPAIR $242.74
57510 ANKLE INSTABILITY - RECONSTRUCTION $380.44
57515 TENDO-ACHILLES REPAIR, ACUTE (W/IN 6 WKS POST-INJ) $352.44
57516 TENDO-ACHILLES REPAIR, CHRONIC (> 6 WKS POST-INJ) $541.49
57520 FLEXOR TENDON REPAIR - ANKLE/FOOT, SINGLE/MULTI $352.44
57525 EXTENSOR TENDON REPAIR - ANKLE/FOOT/WITHOUT GA $121.36
57526 EXTENSOR TENDON REPAIR - ANKLE/FOOT - SINGLE/GA $242.74
57527 EXTENSOR TENDON REPAIR - ANKLE/FOOT - MULTIPLE/GA $336.10
57535 REPAIR/RECONSTRUCTION - TENDON SHEATH $380.44
57550 TENDON TRANSFER- TIBIAL METAPHYSIS/ANKLE/FOOT $434.15
57555 JONES PROCEDURE- TIBIAL METAPHYSIS/ANKLE/FOOT $326.77
57601 OSTEOTOMY/MALUNION - DISTAL TIBIAL $648.87
57602 OSTEOTOMY/MALUNION - MALLEOLUS $434.15
57603 CALCANEAL OSTEOTOMY $520.99
57604 MIDTARSAL OSTEOTOMY $597.51
57605 OSTEOTOMY/MALUNION - METATARSALS $352.44
57606 OSTEOTOMY - OPEN - PHALANGES $242.74
57631 OSTEOTOMY/NON-UNION - DISTAL TIBIAL $541.19
57632 OSTEOTOMY/NON-UNION - MALLEOLUS, LATERAL/MEDIAL $326.77
57633 OSTEOTOMY/NON-UNION - TARSALS $380.44
57634 OSTEOTOMY/NON-UNION - METATARSALS $214.73
57635 OSTEOTOMY/NON-UNION - PHALANGES (FOOT) $214.73
57636 OSTEOTOMY/NON-UNION - EPIPHYSIODESIS $298.77
57637 OSTEOTOMY/NON-UNION - PHYSEAL BAR EXCISION $406.12
57651 BONE GRAFTING - DISTAL TIBIA $242.74
57662 TOTAL ANKLE ARTHROPLASTY- REVISION $1,335.36
57663 TOTAL ANKLE ARTHROPLASTY - REMOVAL $186.72
57671 EXCISION ARTHROPLASTY GREAT TOE (KELLER'S) $270.75
57672 METATARSAL/PHALANGEAL JOINT RESECTION/RECONSTRUCT. $298.77
57673 OSTEOTOMY - DISTAL METATARSAL $298.77
57674 OSTEOTOMY - PROXIMAL METATARSAL/DISTAL REALIGNMENT $434.15
57675 IMPLANT ARTHROPLASTY - METATARSAL PHALANGEAL JOINT $288.77
57676 INTERPHALANGEAL JOINT ARTHROPLASTY, SINGLE/MULTI $270.75
57677 RECONSTRUCTION - MINOR FOREFOOT (LESSER TOES) $380.44
57678 RECONSTRUCTION - MAJOR FOREFOOT $595.16
57701 FRAC/DISLOC ANKLE - CLOSED REDUC. W/ GA $186.72
57702 FRAC/DISLOC ANKLE - EXTERNAL FIXATION $490.15
57705 FRAC/DISLOC ANKLE - ORIF $896.29
57708 FRAC/DISLOC ANKLE - OPEN - PRIMARY WOUND CARE $102.26
57709 FRAC/DISLOC ANKLE - OPEN - SECOND. WOUND CARE $186.72
57711 FRAC/DISLOC ANKLE(MALLEOLAR) - CLOSED RED. W/O GA $93.37
57712 FRAC/DISLOC ANKLE(MALLEOLAR) - CLOSED RED. W/ GA $270.75
57713 FRAC/DISLOC ANKLE(MALLEOLAR) - CLOSED RED. EX FIX $270.75
57715 FRAC/DISLOC ANKLE(MALLEOLAR) - ORIF - ONE $352.44
57716 FRAC/DISLOC ANKLE(MALLEOLAR) - ORIF - TWO OR MORE $406.12
57718 FRAC/DISLOC ANKLE(MALLEOLAR) - PRIM. WOUND CARE $102.26
57719 FRAC/DISLOC ANKLE(MALLEOLAR) - SECOND. WOUND CARE $186.72
57721 HINDFOOT/MIDFOOT/LISFRANC DISLOC - CLOSED W/O GA $93.37
57722 HINDFOOT/MIDFOOT/LISFRANC DISLOC - CLOSED W/ GA $186.72
57723 HINDFOOT/MIDFOOT/LISFRANC DISLOC - CLOSED W/ FIXAT $298.77
57725 HINDFOOT/MIDFOOT/LISFRANC DISLOC - OPEN REDUCTION $475.56
57728 HINDFOOT/MIDFOOT/LISFRANC DISLOC - PRIM.WOUND CARE $102.26
57729 HINDFOOT/MIDFOOT/LISFRANC DISLOC - SEC.WOUND CARE $186.72
57732 OS CALCIS FRACTURE - CLOSED REDUCTION W/ GA $186.72
57733 OS CALCIS FRACTURE - CLOSED REDUCTION W/ FIXATION $298.77
57735 OS CALCIS FRACTURE - ORIF $625.53
57738 OS CALCIS FRACTURE - OPEN - PRIM. WOUND CARE $102.26
57739 OS CALCIS FRACTURE - OPEN - SEC. WOUND CARE $186.72
57741 TALUS FRACTURE - CLOSED REDUCTION W/O GA $93.37
57742 TALUS FRACTURE - CLOSED REDUCTION W/ GA $186.72
57743 TALUS FRACTURE - CLOSED REDUCTION, FIXATION $326.77
57745 TALUS FRACTURE - ORIF $487.81
57748 TALUS FRACTURE - OPEN - PRIM. WOUND CARE $102.26
57749 TALUS FRACTURE - OPEN - SEC. WOUND CARE $186.72
57751 TARSAL FRACTURE - CLOSED REDUCTION W/O GA $93.37
57752 TARSAL FRACTURE - CLOSED REDUCTION W/ GA $186.72
57753 TARSAL FRACTURE - CLOSED REDUCTION, FIXATION $298.77
57755 TARSAL FRACTURE - ORIF $326.77
57758 TARSAL FRACTURE - OPEN - PRIM. WOUND CARE $102.26
57759 TARSAL FRACTURE - OPEN - SEC. WOUND CARE $186.72
57761 METATARSAL FRACTURE - CLOSED REDUCTION, FIXATION $270.75
57765 METATARSAL FRACTURE - ORIF - ONE $298.77
57766 METATARSAL FRACTURE - ORIF - TWO OR MORE $352.44
57768 METATARSAL FRACTURE - OPEN - PRIMARY WOUND CARE $102.26
57769 METATARSAL FRACTURE - OPEN - SECONDARY WOUND CARE $186.72
57771 METATARSO-PHALANGEAL DISLOC.- CLOSED RED. W/O GA $93.37
57772 METATARSO-PHALANGEAL DISLOC. - CLOSED RED. W/ GA $186.72
57773 METATARSO-PHALANGEAL DISLOC. - CLOSED RED, FIX $214.73
57775 METATARSO-PHALANGEAL DISLOC. - ORIF $298.77
57778 METATARSO-PHALANGEAL DISLOC. - OPEN - PRIM. WOUND $102.26
57779 METATARSO-PHALANGEAL DISLOC. - OPEN - SEC. WOUND $186.72
57781 PHALANGEAL FRACTURE - CLOSED REDUCTION, FIXATION $270.75
57785 PHALANGEAL FRACTURE - ORIF $298.77
57788 PHALANGEAL FRACTURE - OPEN - PRIM. WOUND CARE $51.13
57789 PHALANGEAL FRACTURE - OPEN - SEC. WOUND CARE $93.37
57791 INTERPHALANGEAL DISLOC. - CLOSED RED. W/O GA $46.68
57792 INTERPHALANGEAL DISLOC. - CLOSED RED. W/ GA $186.72
57793 INTERPHALANGEAL DISLOC. - CLOSED RED. FIXATION $270.75
57795 INTERPHALANGEAL DISLOC. - OPEN RED. W/WO FIXATION $298.77
57798 INTERPHALANGEAL DISLOC. - OPEN - PRIM.WOUND CARE $51.13
57799 INTERPHALANGEAL DISLOC. - OPEN - SEC.WOUND CARE $93.37
57800 MANIPULATION - ANKLE/FOOT W/ GA $93.37
57810 ARTHRODESIS - TIBIOCALCANEAL $597.51
57811 ARTHRODESIS - PANTALAR $840.26
57812 ARTHRODESIS - ANKLE JOINT $718.88
57813 ARTHRODESIS - SUBTALAR JOINT/TRIPLE $717.01
57814 ARTHRODESIS - MIDTARSAL JOINT $541.49
57815 ARTHRODESIS - TARSO-METATARSAL JOINTS $658.20
57816 ARTHRODESIS - METATARSOPHALANGEAL $352.44
57817 ARTHRODESIS - INTERPHANGEAL, SINGLE OR MULTIPLE $270.75
57980 AMPUTATION - SYME $526.08
57981 AMPUTATION - MIDTARSAL $486.50
57982 AMPUTATION - TRANSMETATARSAL $406.12
57983 AMPUTATION - SINGLE METATARSAL/RAY RESECTION $354.78
57984 AMPUTATION - TOE $185.33
57998 AMPUTATION - OPEN INJURY, PRIMARY WOUND CARE $51.13
57999 AMPUTATION - OPEN INJURY, SECONDARY WOUND CARE $93.37

Vertebra, Facette And Spine

Code Description Amount
00757 ASPIRATION OTHER JOINTS $11.99
03155 LAMINECTOMY - for hematoma, tumour or vascular malformation $948.86
03160 Laminectomy for congenital spinal malformation or tethered spinal cord $2,027.87
03161 Laminectomy for localized spinal stenosis (two levels or less) $789.13
03162 Laminectomy for generalized spinal stenosis (more than two levels) $1,213.99
03167 Insertion of skull tongs (operation only) $126.29
03180 Multiple level laminectomy for cervical cord compression, three or more levels $1,430.75
11830 Needle biopsy - soft tissue/bone - thoracic spine, under GA $214.73
11831 Needle biopsy - soft tissue/bone - lumbar spine, under GA $186.72
11845 Biopsy, with GA $242.74
05721 ASPIRATION - BURSA $23.23
58205 INJECTION/ASPIRATION - FACET JOINT $92.97
58210 DISCOGRAM $92.28
58250 ABSCESS/HEMATOMA - EXTRASPINAL/GA $185.33
58305 DISCECTOMY $268.73
58370 DISCECTOMY - CERVICAL, SINGLE LEVEL $620.87
58375 DISCECTOMY - CERVICAL - >2 LEVELS $801.57
58376 DISCECTOMY - THORACOLUMBAR $1,431.69
58385 VERTEBRAL BODY RESECTION - CERVICAL $1,621.68
58386 VERTEBRAL BODY RESECTION - THORACOLUMBAR $1,890.40
58410 SPINAL INSTRUMENTATION - REMOVAL $509.68
58605 STABILIZATION - POSTERIOR - CERVICAL $537.46
58610 STABILIZATION - SEGMENTAL - CERVICAL $1,079.57
58615 STABILIZATION THORACOLUMBAR/WITHOUT INSTRUMENTATIO $486.50
58620 STABILIZATION THORACOLUMBAR/SIMPLE INSTRUMENTATION $769.13
58625 STABILIZATION - THORACOLUMBAR/SEGMENTAL INSTRUMENT $1,241.74
58630 STABILIZATION THORACOLUMBAR, FUSION/DECOMPRESSION $1,566.07
58635 THORACOLUMBAR FUSION/DECOMPRESSION/MULTIPLE LEVELS $1,834.81
58640 STABILIZATION - ANTERIOR: CERVICAL $500.39
58645 STABILIZATION - CERVICAL - PLATES/DISCECTOMY $982.27
58650 STABILIZATION - CERVICAL - PLATES/VERTEBRECTOMY $1,756.05
58655 STABILIZATION - ANTERIOR - THORACOLUMBAR $945.21
58660 STABILIZATION; ANTERIOR, THORACOLUMBAR/INSTRUMENT $2,024.76
58670 DEFORMITY CORRECTION - THORACOLUMBAR $1,431.69
58675 DEFORMITY CORRECTION - THORACOLUMBAR/ANTERIOR INST $1,700.44
58680 DEFORMITY CORRECTION - CERVICAL $2,427.87
58685 OSTEOTOMY - THORACOLUMBAR- POSTERIOR $2,427.87
58690 DEFORMITY; INSTRUMENTATION/FUSION/POSTERIOR, ADULT $1,756.05
58695 DEFORMITY; INSTRUMENTATION/FUSION/POSTERIOR, CHILD $1,431.69
58710 APPLICATION OF HALO - C-SPINE FRACTURE/DISLOCATION $186.72
58715 CERVICAL SPINE - ORIF $1,000.81
58725 FRACTURE/DISLOCATION, THORACOLUMBAR SPINE/FIXATION $1,297.34
58726 THORACOLUMBAR SPINE; ORIF/FIXATION + DECOMPRESSION $1,566.07

Musculoskeletal Oncology

Code Description Amount
51051 MALIGNANT SUBFASCIAL SOFT TISSUE TUMOUR -SIMPLE $597.51
51052 MALIGNANT SUBFASCIAL SOFT TISSUE TUMOUR - COMPLEX $1,279.05
51053 MALIGNANT BONE TUMOUR - LIMB $1,083.01
51054 SKELETAL DEFECT - RECONSTRUCTION $1,092.35
51055 MALIGNANT GIRDLE TUMOUR - SCAPULA $1,083.01
51056 MALIGNANT GIRDLE TUMOUR - PELVIS/SACRUM $1,624.50
51057 SHOULDER/PELVIS/SACRUM - RECONSTRUCTION $1,092.35
51058 MALIGNANT TUMOR/ROTATION PLASTY - RESECTION $2,175.33

Minor Procedures

Code Description Amount
13610 MINOR LACERATION OR FOREIGN BODY - NO ANAESTHESIA $35.62
13611 MINOR LACERATION/FOREIGN BODY REQUIRING ANAES. $66.35
13612 EXTENSIVE LACERATION GREATER THAN 5CM $13.32
13620 Excision of tumour of skin or subcutaneous tissue or small scar under local anesthetic - up to 5 cm (operation only) $66.35
13630 PARONYCHIA $35.53
13631 NAIL REMOVAL - SIMPLE $35.53
13632 NAIL REMOVAL WITH DESTRUCTION OF NAIL BED $71.89
13633 WEDGE EXCISION OF ONE NAIL $63.44

Peripheral Nerve

Code Description Amount
03196 Exploration, mobilization and transposition $281.48
03198 NEURECTOMY OF MAJOR PERIPHERAL NERVE $222.43
06258 PERIPHERAL NERVE/NEUROLYSIS - EXPLORATION $256.65

Spinal

Code Description Amount
03151 STEREOTAXIC SURGERY $785.28
03152 Bischoff's or longitudinal myelotomy $936.10
03153 Laminectomy with DREZ lesion for pain $1,408.69
03155 LAMINECTOMY - for hematoma, tumour or vascular malformation $948.86
03156 LAMINECTOMY FOR CERVICAL DISC - ONE LEVEL $1,524.64
03157 LAMINECTOMY FOR CERVICAL DISC - MULTIPLE LEVELS $1,874.56
03158 LAMINECTOMY FOR LUMBAR DISC - ONE LEVEL $670.94
03159 LAMINECTOMY FOR LUMBAR DISC - MULTIPLE LEVELS $1,323.50
03160 Laminectomy for congenital spinal malformation or tethered spinal cord $2,027.87
03161 Laminectomy for localized spinal stenosis (two levels or less) $789.13
03162 Laminectomy for generalized spinal stenosis (more than two levels) $1,213.99
03163 Anterior cervical discectomy and fusion - one level $1,429.88
03164 Anterior cervical discectomy and fusion - multiple level $1,936.16
03166 Removal of thoracic disc $2,349.45
03167 Insertion of skull tongs (operation only) $126.29
03168 Laminectomy for intradural spinal cord or extra-medullary tumour or vascular malformation by micro-surgical technique $2,213.98
03169 Fracture of spine without cord injury - open reduction and fusion $686.74
03180 Multiple level laminectomy for cervical cord compression, three or more levels $1,430.75
03185 Postero-lateral microsurgical thoracic discectomy $1,915.56
03231 Repair of spinal CSF leak or pseudomeningocoele $698.96

Skin Grafts

Code Description Amount
06015 REMOVAL OF EXTENSIVE SCARS PER CM OVER 5 CM $8.44
06016 REMOVAL OF TUMOR OR SCAR UNDER GA, UP TO 5 CM $126.26
06017 REMOVAL OF TUMOUR; 5 CM TO 10 CM $258.91
06018 REMOVAL OF TUMOR - MORE THAN 10 CM $447.40
06019 SKIN GRAFTS - SINGLE OR MULTIPLE FLAPS < 2CM $156.57
06050 SKIN GRAFTS - REGIONS OF MAJOR JOINTS AND HANDS $432.65
06051 SKIN GRAFTS - FUNCTIONAL AREAS - FINGER TIP $250.72
07055 GANGLIA - WRIST $202.23

Debridement Of Soft Tissues For Necrotizing Infections Or Severe Trauma

Code Description Amount
70158 DEBRIDEMENT SKIN/SUBCUTANEOUS TISSUE,UP TO 5% BODY SURFACE AREA $235.72
70159 DEBRIDEMENT SKIN/SUBCUTANEOUS TISSUE; EACH SUB 5% OF BODY SURFACE AREA $117.87
70162 DEBRIDEMENT SKIN/SUB/NECROTIC FASCIA / 1ST 5% OF BODY SURFACE AREA $261.93
70163 DEBRIDEMENT SKIN/SUB/NECROTIC FASCIA/EACH SUB 5% OF BODY SURFACE AREA $130.96
70165 DEBRIDEMENT SKIN/FASCIA/MUSCLE/BONE;UP TO 1ST 5% OF BODY SURFACE AREA $288.10
70166 DEBRIDEMENT SKIN/FASCIA/MUSCLE/BONE; EACH SUB 5% OF BODY SURFACE AREA $144.06
70168 ACTIVE WOUND MGMT-ACUTE PHASE AFTER DEBRIDEMENT $78.57
70169 ACTIVE WOUND MGMT/IN OR ACUTE PHASE AFT DEBRIDEMNT $125.72

Other

Code Description Amount
11500 ARTHROSCOPY - HIP JOINT $518.18
57652 BONE GRAFTING - MALLEOLUS, MEDIAL/LATERAL-TARSALS $149.38
57661 TOTAL ANKLE PROSTHESIS $991.26