Cataract surgery with lens implant
Facility: Regional Medical Center
Billing Code: 66984 (CPT)
- CPT Billing Code: 66984
- Insurance Median: $870
- Cash Discount Price: $4,367
- vs. Medicare Baseline: 0.37x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $2,357.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 37% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important fact to know is that a cash price of $4,367 is available for this procedure, which may be lower than the cost of using insurance if your deductible is not yet met. While the facility's negotiated rate with Medical Associates Health Plan - Tri is set at $870, commercial insurance plans often involve high deductibles and administrative fees that can make the out-of-pocket cost exceed the cash price. To minimize expenses, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can sometimes bypass the higher administrative markup associated with insurance billing cycles.
In the broader context of pricing, this procedure has a Medicare benchmark amount of $2,357.81, which serves as a federal cost baseline for evaluating fair market value. The facility's gross charge of $5,459 is significantly higher than the Medicare rate, illustrating the common markup found in commercial billing where list prices are inflated to make negotiated discounts appear larger. Compared to the state average of $1,937 for median paid amounts, the facility's specific negotiated rate of $870 is notably lower, suggesting a competitive contract structure. However, patients must remember that the gross charge does not reflect the actual cost to the patient, and the true value is best understood by comparing all rates against the Medicare benchmark rather than the inflated list price.