Knee arthroscopy at Intermountain Health Delta Community Hospital. CPT 29881.
What Intermountain Health Delta Community Hospital publishes for this service, straight from its standard-charges file, last updated July 28, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$90.00–$6,225range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Medicare Adv HMO | $577 |
| Aetna | Medicare Adv PPO | $577 |
| American Health | Medicare Adv UT HMO I-SNP | $577 |
| Health Partners of Nevada | Medicare Advantage | $577 |
| Health Plan of Nevada | Medicaid | $577 |
| Healthy U | Medicaid | $577 |
| Humana | Medicare Choice PPO | $577 |
| Molina | Medicaid | $577 |
| Molina | Medicare Complete Care HMO SNP | $577 |
| Regence BCBS | MedAdvantage PPO | $577 |
| SelectHealth | Medicaid | $577 |
| SelectHealth | Medicare Advantage | $577 |
| UHC | Medicare Advantage | $577 |
| AG Administrators | USU Athletics | $6,225 |
| AWH Connected | Connected Utah | $6,225 |
| Aetna | Connected | $6,225 |
| Aetna | Standard | $6,225 |
| BYU Athletics | Commercial | $6,225 |
| Campbell Scientific | Commercial | $6,225 |
| Cigna | HMO | $6,225 |
| Cigna | PPO/EPO | $6,225 |
| Deseret Mutual | Commercial | $6,225 |
| EMI Health | Mint | $6,225 |
| EMI Health | Network Care | $6,225 |
| EMI | Commercial | $6,225 |
| Franklin County | Commercial | $6,225 |
| Health Utah | Commercial | $6,225 |
| Juniper Systems | Commercial | $6,225 |
| LW Miller | Commercial | $6,225 |
| Managed Care Admin | Commercial | $6,225 |
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All common services at Intermountain Health Delta Community Hospital