Knee arthroscopy at SSM Health St. Agnes Hospital - Fond du Lac. CPT 29881.
What SSM Health St. Agnes Hospital - Fond du Lac publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$2,427–$8,770range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| MOLINA | Medicare Managed Care Plan | $2,427 |
| BCBS | Anthem Medicare Managed Care Plan | $3,236 |
| Wellcare | Medicare Managed Care Plan | $3,301 |
| BCBS | Blue Preferred / Blue Preferred Plus HMO/POS | $3,735 |
| BCBS | Blue Access PPO | $4,589 |
| BCBS | Blue Traditional Traditional | $4,589 |
| FABOH | All Commercial Plans | $5,067 |
| DOC | Government | $6,246 |
| Network Health Plan | HMO/POS | $8,657 |
| Centivo | Broad(WI1) Other Commercial Plan | $8,770 |
| Centivo | Median(WI2) Other Commercial Plan | $8,770 |
| Centivo | Value(WI3) Other Commercial Plan | $8,770 |
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All common services at SSM Health St. Agnes Hospital - Fond du Lac