CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: Astria Toppenish Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $2,608
Cash Discount Price: $1,695
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at Astria Toppenish Hospital is $2,608. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,695. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.78x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$1,695

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,608

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: $1,695 (51%)

Insurance Median: $2,608 (78%)

Cash: $1,695 (51% of Medicare)

Ins. Median: $2,608 (78% 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
Medicaid / KanCare	$399 - $5,778	12%
Premera_Affordable_Care	$983	29%
Chpw_Cascade_Care	$1,643	49%
First_Choice	$1,800	54%
Ambetter / Centene	$2,014	60%
UnitedHealthcare	$2,014 - $2,154	60%
Tpsc	$2,034	61%
Molina	$2,054	61%
Medicare (plans)	$2,075 - $3,301	62%
Va	$2,175	65%
Aetna	$2,295 - $3,301	69%
Bcchp	$2,608	78%
Great_Rivers	$2,608	78%
Healthcomp	$2,608	78%
Humana	$2,608 - $3,301	78%
Washington_State_Hca	$2,608	78%
Molina_Exchange	$2,618	78%
Li	$3,006	90%
Cigna	$3,301	99%
Tricare	$3,301	99%
Zenith	$3,334	100%
Kaiser	$11,499	344%

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 $1,695.
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 Astria Toppenish 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.