CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Adventist Health Tulare

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $676
Cash Discount Price: $360
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Adventist Health Tulare is $676. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $360. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 0.29x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$360

Average discount available for prompt cash payment at this facility.

Insurance Median

$676

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: $360 (15%)

Insurance Median: $676 (29%)

Cash: $360 (15% of Medicare)

Ins. Median: $676 (29% 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
Blue Shield Mcare	$478	20%
Fhcn Pace Mcr Adv - All Plans	$478	20%
Medicare (plans)	$478	20%
Tricare	$478	20%
UnitedHealthcare	$478 - $704	20%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$478	20%
Ah Employee Health Plan - All Plans	$526	22%
Incentive Hlth - All Plans	$526	22%
Hs Interplan-All Plans	$597	25%
Aetna	$621	26%
Cal Forensic Med Grp - All Plans	$621	26%
Cigna	$676	29%
Healthnet Hmo/Ppo - All Other Plans	$696	30%
Blue Cross Blue Shield	$1,005 - $1,248	43%
Ccipa Medi-Cal - All Plans	$1,005	43%
Healthnet Medi-Cal	$1,005	43%
Medi-Cal	$1,005	43%
Upn-United Physcn Ntwrk Mcal Profee Only	$1,005	43%
Blue Shield Epn	$1,053	45%
Blue Shield-All Other Plans	$1,113	47%

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 $360.
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 Adventist Health Tulare 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.