CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: Kenmore Mercy Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $523
Cash Discount Price: $1,869
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at Kenmore Mercy Hospital is $523. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,869. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.16x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$1,869

Average discount available for prompt cash payment at this facility.

Insurance Median

$523

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: $1,869 (56%)

Insurance Median: $523 (16%)

Cash: $1,869 (56% of Medicare)

Ins. Median: $523 (16% 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.

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
Independent Health Essential [100166]	$308	9%
Tuscarora Nation [550120]	$308	9%
Medicaid / KanCare	$308 - $523	9%
Crime Victims [100176]	$308	9%
Amerigroup [350102]	$308	9%
Blue Cross Blue Shield	$308 - $749	9%
Vna Option Mltc [350110]	$308	9%
Excellus Rochester McD [350117]	$308	9%
UnitedHealthcare	$366 - $602	11%
Univera Healthcare Essential [100170]	$449	13%
Univera Healthcare [100169]	$449 - $661	13%
Beacon Essential [350122]	$471 - $628	14%
VA Veterans Affairs [700001]	$471	14%
Medicare (plans)	$514 - $581	15%
Champ VA [700002]	$523	16%
Cigna	$523 - $758	16%
Covid19 Hrsa [45013]	$523	16%
Catholic Health Life Pace [400005]	$523	16%
Fallon Health [450115]	$523	16%
Tricare	$523	16%
Seneca Nation [450119]	$523	16%
Hospice [550001]	$523	16%
Humana	$549	16%
Aetna	$549	16%
Wellcare Fidelis Dual [450451]	$549	16%
Fidelis Dual Advantage [450120]	$549	16%
Ghi [100153]	$575	17%
Fidelis Essential [100163]	$575	17%
Wellcare [450129]	$575	17%
Beacon Health Options [100023]	$628	19%
Fidelis Exchange [100164]	$628	19%
Mvp Healthcare [100168]	$665	20%
Independent Health [100165]	$685	20%
Iha First Choice [800001]	$685	20%
Molina Essential [100167]	$693	21%
UPMC Health Plan [100181]	$941	28%
No Fault [114001]	$1,780	53%
Federal Workers Compensation [500100]	$1,780	53%

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 $1,869.
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 Kenmore Mercy 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.