CMS Price Transparency Data

Cataract surgery with lens implant

Facility: St Joseph's University Medical Center Inc

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $1,274
Cash Discount Price: $2,180
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at St Joseph's University Medical Center Inc is $1,274. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,180. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 0.54x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$2,180

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,274

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: $2,180 (92%)

Insurance Median: $1,274 (54%)

Cash: $2,180 (92% of Medicare)

Ins. Median: $1,274 (54% 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
Fidelis Care of New Jersey	$384 - $2,879	16%
UnitedHealthcare	$384 - $4,567	16%
Aetna	$512 - $5,593	22%
Ambetter / Centene	$512 - $4,113	22%
Amerihealth	$512 - $2,742	22%
Clover Health	$512 - $2,742	22%
Horizon New Jersey Total Care	$512 - $2,742	22%
Wellpoint	$512 - $2,742	22%
Multiplan	$768	33%
Blue Cross Blue Shield	$833 - $7,807	35%
Oxford	$890 - $4,206	38%
Private Healthcare Systems	$1,417	60%
Consumer Health Network	$1,694	72%
Horizon New Jersey Health	$1,853 - $2,969	79%
Cigna	$2,180	92%
Longevity Health Plan	$3,153	134%

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 $2,180.
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 St Joseph's University Medical Center Inc 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.