Knee arthroscopy at Saint Alphonsus Medical Center-Ontario. CPT 29881.
What Saint Alphonsus Medical Center-Ontario publishes for this service, straight from its standard-charges file, last updated March 31, 2026.
Outpatient / ER
$212cash price (self-pay)
—list price
$16.15–$1,925range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Rx Medi-Cal | Medicaid | $217 |
| Blue Plus Mo Medicaid | Medicaid | $217 |
| Iowa Total Care | Medicaid | $217 |
| Mo Home State Health Plan | Medicaid | $217 |
| Medicaid - Ky | Medicaid | $217 |
| Medicaid - MA | Medicaid | $217 |
| Medicaid - Ks | Medicaid | $217 |
| Medicaid - Ia | Medicaid | $217 |
| County Care Medicaid Advantage | Medicaid | $217 |
| Blue Cross - Oh (Anthem) Medicaid Advantage | Medicaid | $217 |
| La Care Health Plan | Medicaid | $217 |
| Delaware First Health | Medicaid | $217 |
| Commonwealth Care Alliance Medicaid | Medicaid | $217 |
| Medicaid - Md | Medicaid | $217 |
| Rx 340b Pass Along | Medicaid | $217 |
| Rx Meridian Rx | Medicaid | $217 |
| Ascension St. Vincent Public Safety Medical | Medicaid | $217 |
| Cmh Kalamazoo | Medicaid | $217 |
| Rx Allwin | Medicare | $246 |
| Commonwealth Care Alliance Medicare | Medicare | $246 |
| Rx Medicare | Medicare | $246 |
| Blue Cross - Mi Medicare Advantage | Medicare | $246 |
| Coventry Medicare Advantage | Medicare | $246 |
| Blue Cross - Ok | Regence BCBS | $555 |
| Blue Cross - Nv (Anthem) | Regence BCBS | $555 |
| Blue Cross - Mt | Regence BCBS | $555 |
| Blue Shield - Id (Regence) | Regence BCBS | $555 |
| Blue Cross - Id | Regence BCBS | $555 |
| Blue Cross - CA (Anthem) | Regence BCBS | $555 |
| Blue Cross - Ar | Regence BCBS | $555 |
Inpatient
$195cash price (self-pay)
$1,220list price
$14.84–$1,220range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Rx Allwin | Medicare | $246 |
| Reliance Community Care Partners Care Resources Pace | Medicare | $246 |
| Rx Grane Grnmedd | Medicare | $246 |
| Medicare Alternate Payor | Medicare | $246 |
| Genesys Pace Of Genesee County | Medicare | $246 |
| Community Pace At Home | Medicare | $246 |
| Huron Valley Pace Medicaid | Medicaid | $433 |
| New York Cancer Services Program | Medicaid | $433 |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | Medicaid | $433 |
| Pre-Employment | Regence BCBS | $555 |
| Wc Domestic | Regence BCBS | $555 |
| Wc Northeast Health | Workers Comp | $711 |
| Wc Price Chopper | Workers Comp | $711 |
| Wc Generic | Workers Comp | $711 |
| Wc Tyson | Workers Comp | $711 |
| Wc Sheakley Unicomp | Workers Comp | $711 |
| Wc Compone Admin | Workers Comp | $711 |
| Wc Alaska National Ins | Workers Comp | $711 |
| Wc Aims | Workers Comp | $711 |
| Wc Tristar | Workers Comp | $711 |
| Wc Winnebago Industries | Workers Comp | $711 |
| Wc Am Trust N America | Workers Comp | $711 |
| Wc First Agency/Occunet | Workers Comp | $711 |
| Wc Ct Healthcare Trust | Workers Comp | $711 |
| Wc California State Comp Ins | Workers Comp | $711 |
| Wc City Of Sioux City | Workers Comp | $711 |
| Wc Capitol Area Health Consortium | Workers Comp | $711 |
| Wc Cirma | Workers Comp | $711 |
| Wc Smile Lodge | Workers Comp | $711 |
| Wc Emc Insurance Company | Workers Comp | $711 |
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All common services at Saint Alphonsus Medical Center-Ontario