CMS Price Transparency Data

Cataract surgery with lens implant

Facility: St Nicholas Hospital

Billing Code: 66984 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 66984
  • Insurance Median: $4,718
  • Cash Discount Price: $4,325
  • vs. Medicare Baseline: 2.00x Medicare
The contracted insurance negotiated median rate for a Cataract surgery with lens implant at St Nicholas Hospital is $4,718. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,325. Compared to the federal Medicare reimbursement reference rate of $2,357.81, this hospital’s rate is 2.00x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$4,325

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,718

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: $4,325 (183%)
Insurance Median: $4,718 (200%)
Cash: $4,325 (183% of Medicare)
Ins. Median: $4,718 (200% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 200% of the Medicare baseline (a markup of 100%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $731 - $4,931 31%
Community Care Family Care $731 - $1,097 31%
Managed Health Services $731 - $1,097 31%
Medicaid / KanCare $731 - $1,097 31%
Meridian Health Plan $731 - $1,097 31%
Molina Healthcare $775 - $2,205 33%
Triology $775 - $5,177 33%
Aetna $2,205 - $6,553 94%
Humana $2,205 - $6,553 94%
Medica $2,205 94%
Medicare (plans) $2,205 94%
UnitedHealthcare $2,205 - $6,553 94%
Security Health Plan $2,227 - $4,183 94%
Molina Healthcare Of Wi $3,276 139%
Hshs Employees $3,552 151%
Arise Health Plan $3,932 167%
Wea Provider Network $4,063 - $4,718 172%
Cigna $4,587 195%
Interplan $4,587 195%
Network Health Plan $4,587 195%
Health Care Alliance $4,783 203%
Health Eos $4,914 208%
Healthsmart $4,914 208%
Naphcare $4,960 210%
Wisconsin Physician Service $5,242 222%
Multiplan/Phcs $5,504 233%
Choicecare $5,570 236%
North Central Healthcare Alliance $6,028 256%
First Health $6,225 264%
Caterpillar, Inc. $6,553 278%
Cofinity $6,553 278%
Live360 $6,553 278%
P360 Small Group $6,553 278%
Prevea Health Network $6,553 278%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals