CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Memorial Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $4,809
Cash Discount Price: $5,460
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Memorial Hospital is $4,809. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,460. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 2.04x the Medicare baseline. Located in 1454 N County Road 2050 E, Carthage, IL.

Cash / Self-Pay

$5,460

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,809

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: $5,460 (232%)

Insurance Median: $4,809 (204%)

Cash: $5,460 (232% of Medicare)

Ins. Median: $4,809 (204% 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 204% of the Medicare baseline (a markup of 104%). 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
Aetna	$558 - $4,157	24%
Consociate	$558 - $5,801	24%
Cigna	$1,000 - $3,326	42%
Humana	$1,094 - $6,825	46%
Blue Cross Blue Shield	$1,358 - $4,157	58%
First Health Network	$1,374 - $6,074	58%
Health Alliance	$1,911 - $6,825	81%
Meridian	$1,911 - $6,825	81%
Molina	$1,911 - $6,825	81%
UnitedHealthcare	$1,911 - $6,825	81%
Healthlink	$3,300 - $5,801	140%
Private Healthcare Systems	$5,801	246%
Integrated Health Plan	$6,006	255%
Health Dynamics	$6,142	260%
Health Payors Org	$6,142	260%
Iowa Health Solutions	$6,142	260%
Multiplan	$6,142	260%
Preferred Plan Inc	$6,142	260%
Three Rivers Provider Network	$6,142	260%
Health First Network	$6,211	263%
Pponext	$6,211	263%
Corvel	$6,484	275%

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 $5,460.
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 Memorial 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.