CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: St James Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $534
Cash Discount Price: $1,748
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at St James Hospital is $534. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,748. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.16x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

$1,748

Average discount available for prompt cash payment at this facility.

Insurance Median

$534

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: $1,748 (52%)

Insurance Median: $534 (16%)

Cash: $1,748 (52% of Medicare)

Ins. Median: $534 (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
Blue Cross Blue Shield	$256 - $9,779	8%
Medicaid / KanCare	$262 - $542	8%
Fidelis 5155	$398 - $467	12%
Aetna	$445 - $4,374	13%
Excellus 2201	$445 - $523	13%
Medicare (plans)	$445 - $4,812	13%
Mvp 2900	$465 - $9,497	14%
UnitedHealthcare	$471 - $4,374	14%
Cigna	$642 - $9,838	19%
Capital District Physicians Health Plan (Cdphp) 5149	$1,332	40%
Humana	$4,374	131%
Empire Plan 5179	$9,230	276%

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 $1,748.
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 James 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.