CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $3,519
Cash Discount Price: $2,676
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Saint Clare's Hospital/ Denville Campus is $3,519. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,676. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.49x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$2,676

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,519

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: $2,676 (113%)

Insurance Median: $3,519 (149%)

Cash: $2,676 (113% of Medicare)

Ins. Median: $3,519 (149% 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
Humana	$2,141	91%
UnitedHealthcare	$2,150 - $8,190	91%
Aetna	$2,676 - $5,674	113%
Amerihealth	$2,676	113%
Clover Health	$2,676	113%
Horizon	$2,676 - $5,564	113%
Medicare (plans)	$2,676	113%
Tricare	$2,676	113%
Wellcare	$2,676 - $3,613	113%
Wellpoint Amerigroup	$2,676	113%
Ally-Align (Fka Spartan Health Plan)	$2,810	119%
Brighton Health Plan Solutions (Fka Magnacare)	$3,519	149%
Employer Direct Healthcare	$3,747	159%
Cigna	$4,136	175%
Fairprice Healthcare Holdings - Fphh	$4,282	182%
Coventry	$5,353	227%

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 $2,676.
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 Saint Clare's Hospital/ Denville Campus 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.