Cataract surgery with lens implant
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 66984 (CPT)
- CPT Billing Code: 66984
- Insurance Median: $2,178
- Cash Discount Price: $6,972
- vs. Medicare Baseline: 0.92x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $479 - $3,445 | 20% |
| Indian Health Service Contracted [320198] | $479 | 20% |
| Medicaid / KanCare | $755 - $2,220 | 32% |
| UnitedHealthcare | $1,944 - $2,220 | 82% |
| Aetna | $2,031 - $2,178 | 86% |
| Humana | $2,031 - $2,178 | 86% |
| Tricare | $2,178 | 92% |
| Kindful Hospice [20434] | $2,178 | 92% |
| Kindful Hospice Contracted [320434] | $2,178 | 92% |
| Medicare (plans) | $2,178 - $2,267 | 92% |
| Dept Of Veteran Affairs Contracted [320106] | $2,178 | 92% |
| Halo Hcr Inc Hospice Contracted [320432] | $2,178 | 92% |
| Cross Timbers Hospice [20098] | $2,178 | 92% |
| Mercy Hospice Okc [20252] | $2,178 | 92% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $2,178 | 92% |
| Elara Caring Aspire Hospice [20433] | $2,178 | 92% |
| Pace Of The Ozarks Contracted [320518] | $2,178 | 92% |
| Halo Hcr Inc Hospice [20432] | $2,178 | 92% |
| Ambetter / Centene | $2,220 | 94% |
| Home State Health Plan Contracted [320187] | $2,220 | 94% |
| Providrs Care Network Contracted [320484] | $4,219 | 179% |
| Health Choice Contracted [320166] | $4,561 | 193% |
Consumer Guidance & Cost Commentary
For patients undergoing cataract surgery with lens implant at Mercy Hospital Pittsburg, Inc, the financial landscape varies significantly depending on payment method. While the facility's cash median price is $6,972, the negotiated rates paid by insurance plans range from $479 to $4,561, with many major payers settling at $2,178. This data highlights a critical pricing dynamic: for individuals with high-deductible plans, paying the cash price of $6,972 upfront may actually be more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash rate. To minimize out-of-pocket costs, patients should proactively request "self-pay" or "prompt-pay" discounts from the hospital before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing expensive claims processing fees.
When evaluating the facility's pricing against broader benchmarks, it is essential to compare rates to the Medicare amount of $2,357.81 rather than the hospital's gross charge of $10,726.00, as the latter is inflated to make discounts appear larger. The facility's cash median of $6,972.00 represents a significant markup over the Medicare benchmark, whereas the median negotiated rate of $2,178.00 aligns closely with the median allowed amount of $2,252.00 across payers. Consumers should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, meaning unexpected bills for out-of-network ancillary services are often illegal