CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: Tomah Memorial Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $544
Cash Discount Price: $3,260
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at Tomah Memorial Hospital is $544. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,260. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.16x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$3,260

Average discount available for prompt cash payment at this facility.

Insurance Median

$544

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: $3,260 (98%)

Insurance Median: $544 (16%)

Cash: $3,260 (98% of Medicare)

Ins. Median: $544 (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
UnitedHealthcare	$402 - $1,125	12%
Blue Cross Blue Shield	$473 - $1,220	14%
Group Hlth Mcr Adv - All Plans	$473	14%
Independent Care Mcr - All Other Plans	$473	14%
Quartz Mcr Adv	$473	14%
Security Hp Mcr Adv	$473	14%
Va Ccn - All Plans	$473	14%
Aetna	$544 - $4,819	16%
Independent Care Mcaid	$544	16%
Managed Hlth Mcaid - All Plans	$544	16%
Quartz Mcaid	$544	16%
Security Hp Mcaid	$544	16%
The Alliance - All Plans	$2,011	60%
Security Hp Comm - All Other Plans	$4,819	144%
Quartz Comm - All Other Plans	$5,102	153%
Humana	$5,244	157%
Cigna	$5,499	164%

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 $3,260.
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 Tomah Memorial 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.