CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Duke University Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $984
Cash Discount Price: $979
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Duke University Hospital is $984. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $979. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 0.42x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$979

Average discount available for prompt cash payment at this facility.

Insurance Median

$984

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: $979 (42%)

Insurance Median: $984 (42%)

Cash: $979 (42% of Medicare)

Ins. Median: $984 (42% 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
Aetna	$667 - $2,406	28%
Alliance Health	$728 - $984	31%
Blue Cross Blue Shield	$730 - $2,197	31%
UnitedHealthcare	$730 - $3,758	31%
Humana	$747	32%
Amerihealth	$984	42%
Carolina Complete Health	$984	42%
Trillium	$984	42%
Cigna	$1,605	68%
Medcost	$1,853	79%

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 $979.
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 Duke University 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.