Cataract surgery with lens implant
Facility: Providence Medical Center
Billing Code: 66984 (CPT)
- CPT Billing Code: 66984
- Insurance Median: $2,283
- Cash Discount Price: $2,174
- vs. Medicare Baseline: 0.97x 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 |
|---|---|---|
| Medicaid / KanCare | $755 | 32% |
| UnitedHealthcare | $755 - $4,608 | 32% |
| Celtic | $770 - $3,479 | 33% |
| Healthy Blue | $770 - $2,283 | 33% |
| Aetna | $867 - $4,489 | 37% |
| Comp Alliance - Fka Compresults Worker Compensation | $1,256 | 53% |
| Tricare | $2,174 | 92% |
| Cigna | $2,174 | 92% |
| Medicare (plans) | $2,174 | 92% |
| Midland Care Connection | $2,174 | 92% |
| Kansas Superior Select | $2,283 | 97% |
| Corizon | $2,826 | 120% |
| Employer Direct Healthcare | $3,044 | 129% |
| Well Path Prison | $3,044 | 129% |
| Centurion | $3,261 | 138% |
| Naphcare | $3,370 | 143% |
| Blue Cross Blue Shield | $3,479 - $4,022 | 148% |
| Oha Networks | $3,727 | 158% |
| Worker Compensation | $3,842 | 163% |
Consumer Guidance & Cost Commentary
For the CPT code 66984, representing cataract surgery with lens implant, the gross charge at Providence Medical Center in Kansas City is $5,858. While the facility's cash median rate is $2,174, commercial insurance negotiated rates vary significantly across payers, ranging from a low of $755 with Medicaid/KanCare to a high of $4,489 with UnitedHealthcare. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, as the patient would only pay their deductible rather than the full negotiated amount. To minimize costs, patients should verify their specific plan's allowed amount and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can offer substantial fee reductions for upfront payment.
When evaluating pricing against federal benchmarks, the Medicare amount for this procedure is $2,357.81, which serves as the objective baseline for fair pricing. Commercial negotiated rates often average 200% to 300% of Medicare, though fair pricing is typically defined as 120% to 150% of this rate. In this case, the median negotiated rate of $2,283 is slightly below the Medicare benchmark, suggesting a competitive pricing structure compared to the national standard. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to request an itemized billing audit before paying any final invoice to ensure no errors, double-billing, or unbundled codes are