CMS Price Transparency Data

Cataract surgery with lens implant

Facility: St Luke's Wood River Medical Center

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $5,039
Cash Discount Price: $5,599
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at St Luke's Wood River Medical Center is $5,039. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,599. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 2.14x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$5,599

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,039

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: $5,599 (237%)

Insurance Median: $5,039 (214%)

Cash: $5,599 (237% of Medicare)

Ins. Median: $5,039 (214% 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 214% of the Medicare baseline (a markup of 114%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Commercial [1028]	$3,191 - $5,431	135%
Medicare (plans)	$3,191 - $3,255	135%
Veterans Affairs [1056]	$3,191	135%
Blue Cross Blue Shield	$3,223 - $4,787	137%
UnitedHealthcare	$3,351 - $5,067	142%
Aetna	$3,511 - $5,319	149%
Moda [1055]	$4,927	209%
Geha [1065]	$5,067	215%
United Medical Resources [1051]	$5,067	215%
Cigna	$5,207	221%
Providence [1022]	$5,207	221%
Pacificsource [1020]	$5,263	223%
First Health [1064]	$5,319 - $5,431	226%
Webtpa [1071]	$5,319	226%

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 $5,599.
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 St Luke's Wood River Medical Center 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.