CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: Stephens County Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 29881
  • Insurance Median: $11,050
  • Cash Discount Price: $7,800
  • vs. Medicare Baseline: 3.31x Medicare
The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at Stephens County Hospital is $11,050. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,800. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 3.31x the Medicare baseline. Located in 163 Hospital Drive, Toccoa, GA.
Cash / Self-Pay
$7,800

Average discount available for prompt cash payment at this facility.

Insurance Median
$11,050

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%)
Cash / Self-Pay: $7,800 (233%)
Insurance Median: $11,050 (331%)
Cash: $7,800 (233% of Medicare)
Ins. Median: $11,050 (331% 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 331% of the Medicare baseline (a markup of 231%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Amerigroup $4,180 125%
Medicaid / KanCare $4,180 - $4,304 125%
Blue Cross Blue Shield $10,404 311%
Aetna $11,050 331%
UnitedHealthcare $11,440 342%
Cigna $11,700 350%
Caresource $13,000 389%
Medicare (plans) $13,000 389%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 163 Hospital Drive, Toccoa, GA 30577
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals