CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Mt Sinai Hospital Medical Center

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $2,547
Cash Discount Price: $2,694
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Mt Sinai Hospital Medical Center is $2,547. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,694. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.08x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$2,694

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,547

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: $2,694 (114%)

Insurance Median: $2,547 (108%)

Cash: $2,694 (114% of Medicare)

Ins. Median: $2,547 (108% 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
Partners In Hlth - All Plans	$1,540	65%
Blue Cross Blue Shield	$1,720 - $2,586	73%
Compsych Ip/Op Only - All Plans	$2,309	98%
Cigna	$2,325 - $4,757	99%
Tricare	$2,399	102%
Va Healthnet - All Plans	$2,399	102%
Advocate Physician Prtnrs Mcr	$2,473	105%
Cenpatico Illinicare Dual	$2,473	105%
Cenpatico Illinicare Mcr - All Other Plans	$2,473	105%
Humana	$2,473 - $12,085	105%
Lawndale Christian - All Plans	$2,473	105%
Meridian/Harmony D-Snp - All Plans	$2,473	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$2,473	105%
Healthlink Hmo	$2,502	106%
Hfn Platinum	$2,502	106%
Harmony Behavioral Htlh - All Plans	$2,547	108%
Zing Mcr Adv - All Plans	$2,572	109%
Aetna	$2,586 - $8,698	110%
Family Health Network Mcaid - All Plans	$2,586	110%
Molina Mcr - All Other Plans	$2,597	110%
Healthlink Ppo - All Other Plans	$2,694	114%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$2,694	114%
Molina Mcaid	$2,715	115%
Advocate Physician Prtnrs - All Other Plans	$2,720	115%
Ambetter / Centene	$2,720 - $4,041	115%
Hfn Epo	$3,079	131%
Multiplan Complementary Ntwrk	$3,079	131%
Hfn Ppo - All Other Plans	$3,387	144%
Oscar - All Plans	$4,234	180%

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 $2,694.
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 Mt Sinai Hospital 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.