CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Pinckneyville Community Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $3,641
Cash Discount Price: $4,427
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Pinckneyville Community Hospital is $3,641. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,427. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.54x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$4,427

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,641

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: $4,427 (188%)

Insurance Median: $3,641 (154%)

Cash: $4,427 (188% of Medicare)

Ins. Median: $3,641 (154% 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
Humana	$1,638	69%
Umwa Mcr Adv - All Plans	$1,638	69%
UnitedHealthcare	$1,638 - $3,630	69%
Wellcare Mcr Adv - All Plans	$1,638	69%
Aetna	$1,671 - $9,316	71%
Blue Cross Blue Shield	$3,187 - $9,316	135%
Healthlink Hmo	$3,475	147%
Phcs - All Other Plans	$3,630	154%
Cigna	$3,652	155%
Healthlink Ppo - All Other Plans	$3,652	155%
Healthlink Work Comp	$3,652	155%
Phcs Savility	$3,763	160%
Multiplan - All Plans	$3,984	169%
Ambetter / Centene	$9,316	395%
Medicaid / KanCare	$9,316	395%

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 $4,427.
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 Pinckneyville Community 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.