CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Anderson Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $5,066
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.15x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Anderson Hospital is $5,066. 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 2.15x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,066

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: $5,066 (215%)

Ins. Median: $5,066 (215% 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 215% of the Medicare baseline (a markup of 115%). 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
Humana	$457 - $5,066	19%
Medicare (plans)	$457 - $5,066	19%
UnitedHealthcare	$457 - $5,066	19%
Tricare	$509 - $5,974	22%
Medicaid / KanCare	$1,049 - $2,142	44%
Work Comp	$2,171 - $5,548	92%
Aetna	$5,066	215%
Essence	$5,159 - $5,314	219%
Devoted Health Ppo	$5,167	219%
Clear Springs Health	$5,218	221%
Blue Cross Blue Shield	$6,640	282%
Ambetter / Centene	$7,481	317%
Blue Choice	$7,481	317%
Hopetrust	$12,898	547%
Self Pay	$25,000	1060%

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 $X.
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 Anderson 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.