Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).
| DETAIL FOR SERVICES: | Surgery Procedure | Hospital Stay (2 days) | Anesthesia | Physician Services |
| 2020 CPT/HCPCS Primary Code | 470 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Negotiated Private Fee | $4,837.00 | $1,044.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Prossam | $2,280.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Champva | Diagnostic Related Group (DRG) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| First Medical | $1,330.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| First Medical Vital | $1,207.50 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Plan de Salud Menonita | $1,800.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Menonita Vital | $1,260.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Humana Gold Plus / Gold Choice | Diagnostic Related Group (DRG) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Humana | $1,230.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Mapfre | $1,498.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Mcsclassicare | $1,874.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| MCS Life | $1,570.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Medicare | Diagnostic Related Group (DRG) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| MMM | $1,690.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| MMM Vital | $1,270.50 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Panamerican Life | $1,376.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| PMC | $1,690.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Tricare | Diagnostic Related Group (DRG) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Triple S Salud | $1,600.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Triple S Vital | $1,260.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Triple S Advantage | Diagnostic Related Group (DRG) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Negotiated Minimum Charge | $1,207.50 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Negotiated Maximum Charge | $2,280.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) | |
| Discounted Cash Price | $3,869,60 | $835,20 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
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