Knee arthroscopy at Intermountain Health Good Samaritan Medical Center. CPT 29881.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$3,228–$11,080range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aarp | Aarp | $3,228 |
| United Healthcare Mrp | UHC Mrp Php Prime | $3,228 |
| United Healthcare Mrp | UHC Rmhp Mrp Dualcare | $3,228 |
| United Healthcare Mrp | United Healthcare Mrp | $3,228 |
| United Healthcare Mrp | United Healthcare Optum Mrp | $3,228 |
| Kaiser Snp | Kaiser Snp | $3,261 |
| Select Health | Select Health | $3,261 |
| Cigna | Cigna Co Public Option | $3,889 |
| Choicecare Humana | Choicecare Humana HMO EPO | $4,129 |
| Choicecare Humana | Choicecare Humana PPO | $4,129 |
| Cigna | Cigna Connect Exchange | $4,727 |
| Cigna | Cigna Surefit | $4,727 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $5,838 |
| Kaiser Perm HMO | Kaiser Out Of State | $5,838 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $5,838 |
| Kaiser Self Funded | Kaiser Self Funded | $5,838 |
| Cigna | Cigna HMO | $6,297 |
| Cigna | Cigna Indemnity | $6,297 |
| Cigna | Cigna Local Plus | $6,297 |
| Cigna | Cigna Other | $6,297 |
| Cigna | Cigna POS/Qpos | $6,297 |
| Cigna | Cigna PPO | $6,297 |
| Cigna | Eighth Dist Elect Ben Pln | $6,297 |
| Cigna | Health-Partners | $6,297 |
| Aetna | Aetna Colorado Preferred | $6,886 |
| Aetna | Aetna HMO/EPO | $7,617 |
| Aetna | Aetna Indemnity | $7,617 |
| Aetna | Aetna Other | $7,617 |
| Aetna | Aetna POS/Qpos | $7,617 |
| Aetna | Aetna PPO | $7,617 |
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All common services at Intermountain Health Good Samaritan Medical Center