Knee arthroscopy at CHI Health Good Samaritan. CPT 29881.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$1,022–$12,665range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medica | Commercial|ACO | $1,022 |
| Amerigroup | Medicaid|All Plans | $2,643 |
| Centene | Medicaid|IA Total Care | $2,643 |
| IAMolina | Medicaid|All Plans | $2,694 |
| BCBS - NE | Medicare|All Plans | $3,072 |
| Humana | Medicare|All Plans | $3,072 |
| Medica | Medicare|All Plans | $3,072 |
| PACE | Medicare|All Plans | $3,072 |
| United | Medicare|All Plans | $3,072 |
| Centene | Medicare|All Plans | $3,164 |
| Amerigroup | Medicare|All Plans | $3,226 |
| Great Plains | Medicare|All Plans | $3,226 |
| AMPS | Commercial|All Plans | $6,820 |
| Medica | Commercial|CHI Health | $6,944 |
| Medica | Commercial|All Other Plans | $8,159 |
| Greater Omaha Packing | Commercial|Narrow Network | $11,013 |
| Millard Public Schools | Commercial|Narrow Network | $11,013 |
| One World | Commercial|Narrow Network | $11,013 |
| Greater Omaha Packing | Commercial|Broad Network | $12,665 |
| Millard Public Schools | Commercial|Broad Network | $12,665 |
| One World | Commercial|Broad Network | $12,665 |
| Timpte | Commercial|Broad Network | $12,665 |
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