CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: St Anthony Community Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $7,411
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at St Anthony Community Hospital is $7,411. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 2.22x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,411

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3,342.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3,342.87 (100%)

Insurance Median: $7,411 (222%)

Ins. Median: $7,411 (222% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3,342.87 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 222% of the Medicare baseline (a markup of 122%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
World Trade Center Other	$4,064	122%
Hamaspik (McR)	$4,064	122%
Medicare (plans)	$4,064 - $4,349	122%
World Trade Center Fdny	$4,064	122%
Mvp Gold (McR)	$4,064	122%
Affinity By Molina McR	$4,268	128%
Tricare	$6,586	197%
Cigna	$7,268	217%
Oxford Commercial	$7,289	218%
Oxford Exchange	$7,411	222%
UnitedHealthcare	$7,411 - $8,719	222%
Magnacare Preferred	$8,760	262%
Aetna	$9,869 - $10,965	295%
Blue Cross Blue Shield	$10,414 - $12,827	312%
Mvp Exchange	$12,212	365%
Geisinger Health Commercial/Exchange	$13,412	401%
Mvp Hmo/Ppo	$14,367	430%
Self-Pay	$14,440	432%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 29881.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Anthony Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 29881.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.