Knee arthroscopy at Henry Ford Providence Southfield Hospital. CPT 29881.
What Henry Ford Providence Southfield Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$645–$3,632range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Hap Alliance Health | 1212_sjpk,Sjpr Ahlic 20241001 | $645 |
| Hap HMO POS | 1217_sjpk,Sjpr Hap HMO 20241001 | $645 |
| Hap Preferred | 1210_sjpk,Sjpr Hap Preferred 20241001 | $761 |
| Health Plan Of Mi Medicaid HMO | 1083_sjpk,Sjpr Meridian Health Inpati | $1,260 |
| Jvhl - Medicaid Replacement | 1079_sjpk,Sjpr Medicaid HMO Jvhl Inpatie | $1,260 |
| Jvhl - Medicaid Replacement | 1245_sjpk,Sjpr Medicaid Replacement HMO | $1,260 |
| Molina Health | 1081_sjpk,Sjpr Medicaid Replacement Molina Health Inpa | $1,260 |
| Bc Metro Detroit EPO | 1127_sjpr Blue Cross Blue Shield Metro Detroit | $2,619 |
| Bc Metro Detroit HMO | 1133_sjpr Blue Cross Blue Shield Metro Detroit | $2,619 |
| Blue Care Network | 1129_sjpr Blue Cross Blue Shield Bcn 20220401 | $2,619 |
| Bcn Local Network Southeast | 1131_sjpr Blue Cross Blue Shield Bcn Loc | $3,632 |
| Blue Cross PPO | 1137_sjpr Blue Cross Blue Shield PPO 20220401 | $3,632 |
| Blue Cross Traditional | 1135_sjpr Blue Cross Blue Shield Of Michigan | $3,632 |
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All common services at Henry Ford Providence Southfield Hospital