CMS Price Transparency Data

Cataract surgery with lens implant

Facility: HSHS St Elizabeth's Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $2,546
Cash Discount Price: $2,094
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at HSHS St Elizabeth's Hospital is $2,546. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,094. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.08x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.

Cash / Self-Pay

$2,094

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,546

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: $2,094 (89%)

Insurance Median: $2,546 (108%)

Cash: $2,094 (89% of Medicare)

Ins. Median: $2,546 (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
Amish Community	$815	35%
Molina Healthcare	$1,554 - $2,665	66%
Meridian Health Plan	$1,628 - $2,442	69%
Wellfirst	$1,873	79%
Aetna	$1,905 - $2,546	81%
First Health	$2,164	92%
Health Alliance Medical Plans	$2,182 - $2,546	93%
Cigna	$2,298 - $2,909	97%
Healthlink	$2,313 - $2,909	98%
Caterpillar, Inc.	$2,336	99%
UnitedHealthcare	$2,336 - $2,909	99%
Blue Cross Blue Shield	$2,546 - $2,909	108%
Clear Spring Health Of Illinois	$2,546	108%
Health Partners	$2,546	108%
Humana	$2,546	108%
Sae Hospice	$2,546	108%
Consociate Group	$2,560	109%
Choicecare	$2,618	111%
Healthcare Finest Network (Hfn)	$2,618	111%
Multiplan/Phcs	$2,618	111%
Provider Network Of America	$2,618	111%
Celtic Insurance Company	$2,909	123%
City Of Springfield	$2,909	123%
Claim Doc	$2,909	123%
Current Health Solutions	$2,909	123%
Healthscope	$2,909	123%
Hopetrust	$2,909	123%
Illinois Breast And Cervical Cancer Program	$2,909	123%
Interplan	$2,909	123%
Live360	$2,909	123%
Wexford	$2,909	123%
Naphcare	$5,518	234%

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 $2,094.
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 HSHS St Elizabeth'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.