CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: Galion Community Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $9,728
Cash Discount Price: $38,079
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at Galion Community Hospital is $9,728. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38,079. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 2.91x the Medicare baseline. Located in 269 Portland Way South, Galion, OH.

Cash / Self-Pay

$38,079

Average discount available for prompt cash payment at this facility.

Insurance Median

$9,728

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: $38,079 (1139%)

Insurance Median: $9,728 (291%)

Cash: $38,079 (1139% of Medicare)

Ins. Median: $9,728 (291% 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 291% of the Medicare baseline (a markup of 191%). 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
Amerihealth	$631	19%
Blue Cross Blue Shield	$631 - $37,371	19%
Buckeye	$631 - $15,232	19%
Caresource	$631	19%
Humana	$631 - $15,232	19%
Medicaid / KanCare	$631	19%
Molina	$631 - $24,370	19%
Ohiorise	$631	19%
United_Healthcare	$662 - $34,633	20%
Medicare (plans)	$4,142 - $15,232	124%
Mount_Carmel	$4,142 - $15,232	124%
Aetna	$4,224 - $44,799	126%
Medical_Mutual	$4,224 - $35,839	126%
Cigna	$38,737	1159%

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 $38,079.
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 Galion 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.