CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Northside Hospital Forsyth

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 66984
  • Insurance Median: $4,274
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.81x Medicare
The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Northside Hospital Forsyth is $4,274. 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 1.81x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,274

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: $4,274 (181%)
Ins. Median: $4,274 (181% 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.

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
One Call Diagnostics $696 30%
Mti $870 37%
Homelink $924 39%
Blue Cross Blue Shield $2,307 - $34,850 98%
Clear Springs Eon Health $2,307 98%
Medicare (plans) $2,307 - $2,813 98%
UnitedHealthcare $2,307 - $7,889 98%
Va Ccn $2,307 98%
Humana $2,330 - $2,399 99%
Bccp $2,344 99%
Cbww $2,344 99%
Truths Community $2,344 99%
Aetna $2,353 - $15,436 100%
Coventry $2,353 - $30,000 100%
Caresource $2,376 - $18,600 101%
Kaiser $2,376 - $4,274 101%
Wellcare $2,376 101%
Clover Health $2,421 103%
Pruitt Health Premier $2,422 103%
Fairly Group $2,651 112%
Us Dept Of Labor Wc $2,930 124%
Lantern $3,643 155%
Genex/Priority Care Solutions $4,292 182%
Spreemo $4,292 182%
Authentic 4D $4,828 205%
Streamline Imaging $4,828 205%
Ambetter / Centene $5,011 - $9,299 213%
Tricare $5,318 226%
Corvel Workers Comp $5,364 227%
Employers Choice Network $5,364 227%
Fieldale Farms Wc $5,364 227%
Georgia Workers Compensation $5,364 227%
Amerigroup $6,025 - $7,112 256%
Medicaid / KanCare $6,025 - $6,928 256%
Oscar $6,868 291%
Cigna $7,181 - $10,744 305%
Northside Health Network $7,200 305%
Health One Alliance_Ppo $12,000 509%
Quick Trip $27,500 1166%
Novanet_Ppo $35,000 1484%
Phcs $37,500 1590%
Champus Va $50,000 2121%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1200 Northside Forsyth Drive, Cumming, GA 30041
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals