CMS Price Transparency Data

Knee arthroscopy with meniscus repair

Facility: Stoughton Hospital

Billing Code: 29881 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 29881
Insurance Median: $1,092
Cash Discount Price: $4,193
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Knee arthroscopy with meniscus repair at Stoughton Hospital is $1,092. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,193. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.33x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$4,193

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,092

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: $4,193 (125%)

Insurance Median: $1,092 (33%)

Cash: $4,193 (125% of Medicare)

Ins. Median: $1,092 (33% 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
Healthnet Mcr Adv - All Plans	$402	12%
Tricare	$402	12%
Aetna	$473 - $5,946	14%
Dean Health Insurance Med Adv	$473	14%
Quartz Mcr Adv	$473	14%
Security Health/First Health - All Plans	$473	14%
UnitedHealthcare	$473 - $6,099	14%
Medicaid / KanCare	$489	15%
Humana	$594 - $6,861	18%
Blue Cross Blue Shield	$1,036	31%
Quartz Health Solutions - All Other Lans	$1,092	33%
Wps - All Plans	$1,520	45%
Dean Health Insurance Comm - All Other Plans	$1,590	48%
Dean Health Insurance Epo	$1,590	48%
Alliance - All Plans	$1,751	52%
Geha - All Plans	$5,717	171%
Cigna	$6,099	182%
Wisconsin Ppo Ppa Direct - All Plans	$6,099	182%

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 $4,193.
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 Stoughton 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.