CMS Price Transparency Data
Cataract surgery with lens implant
Facility: Physicians Care Surgical Hospital
Billing Code: 66984 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 66984
- Insurance Median: $6,696
- Cash Discount Price: $6,160
- vs. Medicare Baseline: 2.84x Medicare
The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Physicians Care Surgical Hospital is $6,696. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,160. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 2.84x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$6,160
Average discount available for prompt cash payment at this facility.
Insurance Median
$6,696
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$2,357.81
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $2,357.81 (100%)
Cash / Self-Pay: $6,160 (261%)
Insurance Median: $6,696 (284%)
Cash: $6,160 (261% of Medicare)
Ins. Median: $6,696 (284% of 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 284% of the Medicare baseline (a markup of 184%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Keystone First Healthplan | $900 - $2,850 | 38% |
| Keystone First Vip Choice | $900 - $2,850 | 38% |
| Medicaid / KanCare | $900 - $2,850 | 38% |
| PA Health and Wellness | $900 - $2,850 | 38% |
| Straight Access | $900 - $2,850 | 38% |
| Keystone First | $900 - $2,850 | 38% |
| Tricare | $1,318 - $12,772 | 56% |
| Humana | $1,318 - $12,772 | 56% |
| Connecticare | $2,109 - $19,575 | 89% |
| Gpm Health and Life Insurance Mc Supplement | $2,628 - $12,772 | 111% |
| UnitedHealthcare | $2,628 - $27,099 | 111% |
| Aetna | $2,628 - $23,230 | 111% |
| Ibc Security 65 | $2,628 - $12,363 | 111% |
| Unified Health Services | $2,628 - $12,772 | 111% |
| Devon Health Services | $2,628 - $12,772 | 111% |
| Pcsh Aarp | $2,628 - $12,772 | 111% |
| Shenandoah Life | $2,628 - $12,772 | 111% |
| Medicare (plans) | $2,628 - $12,772 | 111% |
| Cigna | $2,628 - $18,977 | 111% |
| Aarp | $2,628 - $12,772 | 111% |
| Blue Cross Blue Shield | $2,628 - $23,941 | 111% |
| Keystone 65 HMO | $2,628 - $12,772 | 111% |
| Vibra Health Plan | $2,628 - $12,772 | 111% |
| Personal Choice 65 | $2,628 - $12,363 | 111% |
| Ibc - Local | $2,838 - $18,753 | 120% |
| Keystone HMO | $2,838 - $18,753 | 120% |
| Independence Bc | $2,838 - $18,753 | 120% |
| Independence Federal | $2,838 - $18,753 | 120% |
| Carefirst Administrators | $2,838 - $18,753 | 120% |
| Horizon of New Jersey | $2,838 - $18,753 | 120% |
| Ibc 2021 | $2,838 - $18,753 | 120% |
| Personal Choice | $2,838 - $18,753 | 120% |
| Regence Blue Shield | $2,838 - $18,753 | 120% |
| Pcsh Ibc | $2,838 - $18,753 | 120% |
| Amerihealth Administrators | $2,838 - $18,753 | 120% |
| Keystone Healthplan East | $2,838 - $18,753 | 120% |
| Ibc Local | $2,838 - $18,753 | 120% |
| Amerihealth New Jersey HMO | $2,838 - $18,753 | 120% |
| Independence Administrators | $2,838 - $18,753 | 120% |
| Keystone Direct POS | $2,838 - $18,753 | 120% |
| Empire Plan | $2,838 - $18,753 | 120% |
| Ibc | $2,838 - $18,753 | 120% |
| UPMC | $3,448 - $19,295 | 146% |
| Loomis | $3,694 - $18,977 | 157% |
| Health Partners | $3,694 - $18,977 | 157% |
| Apwu | $3,694 - $18,977 | 157% |
| Cwi Benefits | $3,694 - $18,977 | 157% |
| Nalc Health | $3,694 - $18,977 | 157% |
| Freedom Life Insurance Company | $3,694 - $18,977 | 157% |
| Sana Benefits | $3,694 - $18,977 | 157% |
| Healthgram | $3,694 - $18,977 | 157% |
| Highmark | $4,110 - $23,941 | 174% |
| Oxford Life Insurance Company | $5,575 - $27,099 | 236% |
| Oxford Health Plan | $5,575 - $27,099 | 236% |
| Golden Rule Op | $5,575 - $27,099 | 236% |
| Surest | $5,575 - $27,099 | 236% |
| Allsavers | $5,575 - $27,099 | 236% |
| Central PA Teamsters | $6,501 - $21,231 | 276% |
| Marpai Health | $6,696 - $23,230 | 284% |
| Coventry | $6,696 - $23,230 | 284% |
| Allied Benefit Systems | $6,696 - $23,230 | 284% |
| Trustmark | $6,696 - $23,230 | 284% |
| Lucent Health | $6,696 - $23,230 | 284% |
| Healthez | $6,696 - $23,230 | 284% |
| Premier Care Network | $6,696 - $23,230 | 284% |
| Meritain Health | $6,696 - $23,230 | 284% |
| Allied Benefits Systems | $6,696 - $23,230 | 284% |
| Continental Benefits | $6,696 - $23,230 | 284% |
| Ag Administrators | $6,696 - $23,230 | 284% |
| Ag Administrators Inc | $6,696 - $23,230 | 284% |
| Geha | $6,696 - $23,230 | 284% |