CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Sanford Hillsboro

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $4,291
Cash Discount Price: $4,161
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Sanford Hillsboro is $4,291. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,161. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.82x the Medicare baseline. Located in 12 Third Street Se, Hillsboro, ND.

Cash / Self-Pay

$4,161

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,291

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: $4,161 (176%)

Insurance Median: $4,291 (182%)

Cash: $4,161 (176% of Medicare)

Ins. Median: $4,291 (182% 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
Blue Cross Blue Shield	$1,259 - $4,812	53%
Sanford Health Plan Align	$2,372	101%
Ucare	$2,548 - $4,570	108%
Aetna	$2,569 - $4,520	109%
Health Partners	$2,569 - $4,057	109%
Medicare (plans)	$2,569	109%
UnitedHealthcare	$2,569 - $4,343	109%
Primewest	$2,621	111%
Security Health Plan	$2,861	121%
Sanford Health Plan	$4,106 - $4,830	174%
Medica	$4,291 - $4,587	182%
First Choice Health Network	$4,681	199%
Healthez	$4,681	199%
Multiplan	$4,681	199%

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 $4,161.
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 Sanford Hillsboro 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.