CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Pacifica Hospital of the Valley

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $2,214
Cash Discount Price: $27,945
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Pacifica Hospital of the Valley is $2,214. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,945. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 0.94x the Medicare baseline. Located in 9449 San Fernando Rd, Sun Valley, CA.

Cash / Self-Pay

$27,945

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,214

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: $27,945 (1185%)

Insurance Median: $2,214 (94%)

Cash: $27,945 (1185% of Medicare)

Ins. Median: $2,214 (94% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Alignment Health	$1,728	73%
America Cash Health Plan	$2,160	92%
Blue Cross Blue Shield	$2,160 - $27,945	92%
Care 1St Health Plan	$2,160	92%
Humana	$2,160	92%
La Health Care	$2,160	92%
Bright Health Group	$2,268	96%
Health Net Of California	$2,700	115%
Aetna	$13,973	593%
Altamed	$27,945	1185%
Heritage Provider Network	$27,945	1185%
Molina	$27,945	1185%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $27,945.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 66984.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pacifica Hospital of the Valley is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 66984.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.