CMS Price Transparency Data

Cataract surgery with lens implant

Facility: UCSF Health St. Mary's Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $3,349
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at UCSF Health St. Mary's Hospital is $3,349. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.42x the Medicare baseline. Located in 450 Stanyan St, San Francisco, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,349

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%)

Insurance Median: $3,349 (142%)

Ins. Median: $3,349 (142% 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
Brown Toland	$648 - $3,349	27%
California Health & Wellness	$1,154	49%
Kaiser	$1,154 - $3,349	49%
Partnership Health Plan	$1,154	49%
Health Net	$1,396 - $11,962	59%
Sfhp	$1,407	60%
Blue Cross Blue Shield	$1,788 - $21,510	76%
Health Plan San Mateo	$1,818 - $3,349	77%
Aetna	$3,349	142%
Blue Shield Ca	$3,349 - $17,092	142%
Chinese Community	$3,349	142%
Connected Care	$3,349	142%
Humana	$3,349	142%
Mhn	$3,349	142%
United	$3,349	142%
Kentfield	$9,712	412%
Oscar	$10,985	466%

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 $X.
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 UCSF Health St. Mary's Hospital 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.