Knee arthroscopy at Good Samaritan Hospital (GSH). CPT 29881.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$474–$6,924range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Direct Health | Direct Health | $474 |
| Anthem | Trad/PPO/HMO | $792 |
| OneCare | Commercial | $830 |
| Encore Prime | Commercial | $879 |
| Aetna | Commercial | $1,038 |
| Anthem | HealthSync | $1,058 |
| Anthem HIP | HIP | $1,374 |
| BCBS | Medicare Advantage | $1,374 |
| Anthem | Medicaid | $1,384 |
| Caresource HIP | Medicaid | $1,384 |
| Caresource | Medicaid | $1,384 |
| HealthLink | HMO | $1,777 |
| HealthLink | PPO | $1,871 |
| Aetna | Medicare Advantage | $1,968 |
| Allwell | MCR ADV/PPO/HMO | $1,968 |
| Anthem MCR | MCR ADV/PPO/HMO | $1,968 |
| Anthem MCR | Medicare Advantage | $1,968 |
| Anthem | MCR ADV/PPO/HMO | $1,968 |
| Cigna | Medicare Advantage | $1,968 |
| Humana | Medicare Advantage | $1,968 |
| United Healthcare | Medicare Advantage | $1,968 |
| Aetna | Medicaid | $2,274 |
| Anthem Pathways | Medicaid | $2,274 |
| Meridian | Medicaid | $2,274 |
| UHC CareConnect | Medicaid | $2,274 |
| UHC | Medicaid | $2,274 |
| Alliance Coal | Commercial | $2,833 |
| CareSource | Commercial | $2,893 |
| Amish | Commercial | $2,900 |
| Indiana University | MCR ADV/PPO/HMO | $3,462 |
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