CMS Price Transparency Data

Cataract surgery with lens implant

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 66984
Insurance Median: $2,375
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Cataract surgery with lens implant at UPMC Children's Hospital of Pittsburgh is $2,375. 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 1.01x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,375

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: $2,375 (101%)

Ins. Median: $2,375 (101% 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
Aetna	$573 - $2,392	24%
Health Plan Of Upper Ohio Valley	$1,302 - $2,174	55%
Upmc Health Plan	$1,391 - $6,397	59%
Amerihealth Caritas	$2,256 - $2,348	96%
Blue Cross Blue Shield	$2,307 - $6,184	98%
Health Partners Plans (Jefferson Health Plan)	$2,332	99%
Cigna	$2,348	100%
Highmark Wholecare (Prev Gateway)	$2,431	103%
Pa Health & Wellness	$2,442	104%
Geisinger	$2,477	105%
UnitedHealthcare	$6,566	278%

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 UPMC Children's Hospital of Pittsburgh 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.