Knee arthroscopy at Pali Momi Medical Center. CPT 29881.
What Pali Momi Medical Center publishes for this service, straight from its standard-charges file, last updated February 12, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$664–$8,072range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Alohacare | Abd - Adult | $664 |
| Alohacare | Abd - Pediatric | $664 |
| Blended Rate UHC | All Products | $664 |
| UHC | All Products | $664 |
| Ohana | Quest - Abd | $683 |
| Hmsa | Quest Abd | $848 |
| Hmsa | Quest Non-Abd | $2,651 |
| Alohacare | Medicare Advantage | $3,180 |
| Hmsa | Medicare Advantage | $3,180 |
| Mdx | Humana Medicare | $3,180 |
| Mdx | UHC Medicare | $3,180 |
| Ohana | Medicare Advantage | $3,307 |
| Devoted | Medicare Advantage | $3,339 |
| Ohana | Quest - Non-Abd | $3,846 |
| Alohacare | Non-Abd - Adult | $4,231 |
| Alohacare | Non-Abd - Pediatric | $4,231 |
| Hcha | All Products | $4,572 |
| Verdegard | Union Trust Fund | $5,165 |
| Mdx | All Products | $5,484 |
| Hwmg/Hmaa | All Products | $6,585 |
| Mimoh | All Products | $6,996 |
| Pac Admin | All Products | $7,252 |
| Hmsa | All Products | $7,638 |
| Uha | All Products | $8,072 |
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