CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: St Nicholas Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 29881
  • Insurance Median: $8,091
  • Cash Discount Price: $8,236
  • vs. Medicare Baseline: 2.42x Medicare
The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at St Nicholas Hospital is $8,091. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,236. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 2.42x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$8,236

Average discount available for prompt cash payment at this facility.

Insurance Median
$8,091

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: $8,236 (246%)
Insurance Median: $8,091 (242%)
Cash: $8,236 (246% of Medicare)
Ins. Median: $8,091 (242% 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 242% of the Medicare baseline (a markup of 142%). 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
Blue Cross Blue Shield $917 - $8,849 27%
Community Care Family Care $917 - $1,375 27%
Managed Health Services $917 - $1,375 27%
Medicaid / KanCare $917 - $1,375 27%
Meridian Health Plan $917 - $1,375 27%
Molina Healthcare $972 - $3,136 29%
Triology $972 - $9,858 29%
Aetna $3,136 - $12,479 94%
Humana $3,136 - $12,479 94%
Medica $3,136 94%
Medicare (plans) $3,136 94%
UnitedHealthcare $3,136 - $10,877 94%
Security Health Plan $3,168 - $7,965 95%
Molina Healthcare Of Wi $6,240 187%
Hshs Employees $6,764 202%
P360 Small Group $6,793 - $10,190 203%
Prevea Health Network $6,793 - $10,190 203%
Naphcare $7,057 211%
Arise Health Plan $7,487 224%
Wea Provider Network $7,737 - $8,985 231%
Cigna $8,735 261%
Interplan $8,735 261%
Network Health Plan $8,735 261%
Health Care Alliance $9,110 273%
Health Eos $9,359 280%
Healthsmart $9,359 280%
Wisconsin Physician Service $9,983 299%
Multiplan/Phcs $10,482 314%
Choicecare $10,607 317%
North Central Healthcare Alliance $11,481 343%
First Health $11,855 355%
Caterpillar, Inc. $12,479 373%
Cofinity $12,479 373%
Live360 $12,479 373%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals