Knee arthroscopy at St. Luke's Jerome Standard Charges. CPT 29881.
What St. Luke's Jerome Standard Charges publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$6,877cash price (self-pay)
$6,877list price
$3,038–$9,807range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $3,159 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $3,159 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $3,159 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $3,159 |
| Commercial [1028] | Hb Mv Slhp Select Health | $3,159 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $3,159 |
| Mountain Health Co-Op [1067] | Hb Mv Slhp Mountain Health Coop | $3,159 |
| Commercial [1028] | Hb Mv Va Ccn | $3,653 |
| Medicare Advantage Generic [1019] | Hb Mv Medicare Advantage | $3,653 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Mmcp | $3,653 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Mmcp | $3,653 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Pacificsource HMO PPO | $3,653 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Slhp Pacificsource Med | $3,653 |
| Medicare Advantage Regence [1016] | Hb Mv Medicare Advantage | $3,653 |
| Blue Cross/Medicare Advantage [1009] | Hb Mv Bci True & Secure Med Adv | $3,690 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Med Adv | $3,726 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Med Adv | $3,726 |
| Medicare Advantage UHC [1013] | Hb Mv Aarp Optum Ubh Med Adv | $3,836 |
| Medicare Advantage Aetna [1017] | Hb Mv Aetna Med Adv | $4,018 |
| Commercial [1028] | Hb Mv H2b | $5,158 |
| H2b [1068] | Hb Mv H2b | $5,158 |
| Aetna [1021] | Hb Mv Bp Aetna | $5,502 |
| Cigna [1062] | Hb Mv Cigna | $5,502 |
| Commercial [1028] | Hb Mv Bp Aetna | $5,502 |
| Commercial [1028] | Hb Mv Cigna | $5,502 |
| Commercial [1028] | Hb Mv Amps | $5,845 |
| Commercial [1028] | Hb Mv Christian Health Aid | $5,845 |
| Commercial [1028] | Hb Mv First Choice Health | $5,845 |
| First Health [1064] | Hb Mv First Choice Health | $5,845 |
| Commercial [1028] | Hb Mv Moda Commercial | $6,052 |
Inpatient
$8,372cash price (self-pay)
$8,372list price
$5,442–$7,953range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $5,442 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $5,442 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $5,442 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $5,442 |
| Commercial [1028] | Hb Mv Slhp Select Health | $5,442 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $5,442 |
| Medicare Advantage Pacificsource [1039] | Hb Mv Slhp Pacificsource Med | $5,442 |
| Mountain Health Co-Op [1067] | Hb Mv Slhp Mountain Health Coop | $5,442 |
| Pacificsource [1020] | Hb Mv Pacificsource Navigator Large Group | $5,442 |
| Pacificsource [1020] | Hb Mv Slhp Pacificsource Navigator Qhp | $5,442 |
| Select Health [1063] | Hb Mv Slhp Select Health | $5,442 |
| Select Health [1063] | Hb Mv Slhp Select Health Qhp | $5,442 |
| St Lukes Health Plan [1046] | Hb Mv Slhp St Lukes Health Plan Large Gr | $5,442 |
| St Lukes Health Plan [1046] | Hb Mv Slhp St Lukes Health Plan Qhp | $5,442 |
| Commercial [1028] | Hb Mv H2b | $6,279 |
| H2b [1068] | Hb Mv H2b | $6,279 |
| Pacificsource [1020] | Hb Mv Pacificsource PPO Voyager | $6,279 |
| Aetna [1021] | Hb Mv Bp Aetna | $6,698 |
| Cigna [1062] | Hb Mv Cigna | $6,698 |
| Commercial [1028] | Hb Mv Bp Aetna | $6,698 |
| Commercial [1028] | Hb Mv Cigna | $6,698 |
| Commercial [1028] | Hb Mv Multiplan Primary Network | $6,698 |
| Commercial [1028] | Hb Mv Va Ccn | $6,698 |
| Providence [1022] | Hb Mv Cigna | $6,698 |
| Commercial [1028] | Hb Mv Amps | $7,116 |
| Commercial [1028] | Hb Mv Christian Health Aid | $7,116 |
| Commercial [1028] | Hb Mv First Choice Health | $7,116 |
| First Health [1064] | Hb Mv First Choice Health | $7,116 |
| Blue Cross Federal [1008] | Hb Mv Bci PPO Fep | $7,158 |
| Blue Cross Idaho [1007] | Hb Mv Bci PPO Fep | $7,158 |
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