CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: St Nicholas Hospital

Billing Code: 29881 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$5,248

about 1.6× the $3,343 Medicare rate · typically $3,205–$7,462

modeled estimate · not a bill or quote

What this hospital charges insurers

$6,793

Above the fair price

about $1,545 over the fair price · 2.0× Medicare

Medicare pays $3,343 Fair price $5,248 This hospital $6,793 Cash price $8,236 Hospital's list price $12,479

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $544 Priciest $6,793

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Knee arthroscopy with meniscus repair is about $5,248 (about 1.6× the $3,343 Medicare rate). St Nicholas Hospital charges insurers about $6,793, or about $8,236 in cash — above the fair price. Located in Sheboygan, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $5,248. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$3,136 - $10,877	94%
Blue Cross Blue Shieldmajor	$917 - $8,849	27%
Aetnamajor	$3,136 - $12,479	94%
Cignamajor	$8,735	261%
Humanamajor	$3,136 - $12,479	94%
Health Net	$6,793 - $10,190	203%
Medica	$3,136	94%
Meridian	$917 - $1,375	27%
Molina	$972 - $6,240	29%
Security Health Plan	$3,168 - $7,965	95%
+ 15 smaller / regional plans	$917 - $12,479

Government programs also on file: Medicare, Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 8,236), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 29881.

Insurance Before you use insurance

Call your insurance company to confirm St Nicholas Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 29881.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Nicholas Hospital

Compare: Knee arthroscopy with meniscus repair at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.