CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Saint Joseph Regional Medical Center

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 66984
  • Insurance Median: $4,316
  • Cash Discount Price: $9,667
  • vs. Medicare Baseline: 1.83x Medicare
The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Saint Joseph Regional Medical Center is $4,316. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,667. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.83x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$9,667

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,316

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: $9,667 (410%)
Insurance Median: $4,316 (183%)
Cash: $9,667 (410% of Medicare)
Ins. Median: $4,316 (183% 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.

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 $1,264 - $3,785 54%
Blue Cross Blue Shield $1,264 - $8,621 54%
Medicaid / KanCare $1,264 - $4,316 54%
UnitedHealthcare $1,264 - $4,316 54%
Medicare (plans) $2,442 - $2,491 104%
Meridian Complete $2,442 104%
Pace-Trinity Health $2,442 104%
County Coroner $2,539 108%
Provider Partners Health Plan Of Indiana $2,686 114%
Auxiant $3,663 - $5,250 155%
Physicians Health Plan Northern Indiana Health Insurance $3,663 - $7,374 155%
St Joseph County Hlth Dpt $3,663 155%
Caresource $3,785 161%
Siho Insurance Services $3,907 166%
Managed Health Services - Indiana $4,316 183%
Mdwise $4,316 183%
Key Benefit Administrator $4,395 - $5,250 186%
Allied Benefit Systems $4,639 197%
Custom Design Benefits $5,250 223%
Blue Benefit Administrators Of Massachusetts $8,621 366%
Blue Care Network $8,621 366%
Blue Distinction Transplant $8,621 366%
Blue Shield - Ca $8,621 366%
Blue Shield - Id (Regence) $8,621 366%
Blue Shield - Ny Highmark Northeastern $8,621 366%
Blue Shield - Ny Highmark Western $8,621 366%
Blue Shield - Pa (Highmark) $8,621 366%
Blue Shield - Wa (Regence) $8,621 366%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals