CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Tri Valley Health System

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $3,008
Cash Discount Price: $3,896
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Tri Valley Health System is $3,008. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,896. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.28x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$3,896

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,008

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: $3,896 (165%)

Insurance Median: $3,008 (128%)

Cash: $3,896 (165% of Medicare)

Ins. Median: $3,008 (128% 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	$1,905 - $4,113	81%
Humana	$1,905	81%
Medica Mcr Adv	$1,905	81%
Medica Prime Sol	$1,905	81%
Tricare	$1,905	81%
Wellcare Mcr Adv - All Plans	$1,905	81%
Great Plains Mcr Adv - All Plans	$2,000	85%
Healthy Blue Mcaid - All Plans	$2,078	88%
Molina Mcaid - All Plans	$2,078	88%
Nebraska Total Care-All Plans	$2,078	88%
UnitedHealthcare	$2,078 - $4,156	88%
Amerigroup Mcaid - All Plans	$2,119	90%
Medica Chi Aco - All Other Plans	$3,896	165%
Medica Chi Open Access	$3,896	165%
Medica Ifb Aco	$3,896	165%
Medica Ifb Open Access	$3,896	165%
Midlands Choice-All Plans	$3,896	165%
Aetna	$4,242	180%
Multiplan-All Plans	$4,242	180%

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 $3,896.
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 Tri Valley Health System 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.