CMS Price Transparency Data

Cataract surgery with lens implant

Facility: Harlem Hospital Center

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $2,516
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at Harlem Hospital Center is $2,516. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 1.07x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,516

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%)

Insurance Median: $2,516 (107%)

Ins. Median: $2,516 (107% 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
Emblem	$213 - $4,821	9%
Oxford	$236 - $3,052	10%
Oscar	$251 - $4,454	11%
United	$284 - $3,260	12%
Healthfirst	$474 - $5,502	20%
Wellcare	$640	27%
Aetna	$758 - $3,502	32%
Fidelis	$854 - $5,502	36%
Metroplus	$1,200 - $5,502	51%
Blue Cross Blue Shield	$1,980 - $5,502	84%
Amidacare	$2,445	104%
Carelon	$2,445 - $4,529	104%
Senior Whole Health	$2,445	104%
United Behavioral Health	$2,445 - $2,690	104%
Affinity	$2,494 - $5,502	106%
Carelon (Amida Care)	$2,494	106%
Vnsny	$2,494 - $2,699	106%
Elderplan	$2,699	114%
Vaccn	$2,699	114%
Centers Plan For Healthy Living	$2,807	119%
Centerlight	$3,484	148%
Cigna	$4,285 - $5,226	182%
Local 1199	$5,049 - $5,922	214%
Magnacare	$5,226	222%
Multiplan	$5,574	236%
Villagecare Max	$5,922	251%

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 $X.
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 Harlem Hospital Center 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.