Medical Procedure Costs in Pennsylvania
Pennsylvania Medicare physician rates are generally near the national average. CMS uses 2 localities here, so a ZIP matters.
Look up any CPT in Pennsylvania
Featured table below is 59 procedures. Search covers 7,500+ fee-schedule codes.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. These Pennsylvania averages are unweighted means of the state’s localities, not population-weighted.
How Medicare prices Pennsylvania
Pennsylvania's fee schedule separates metro Philadelphia from the rest of the state, giving the southeast its own higher-cost locality while Pittsburgh, Harrisburg, Allentown, Erie, and rural Pennsylvania share rest-of-state adjustments. That means the state's second-largest medical market, Pittsburgh, is priced with rural counties rather than with Philadelphia. The Philadelphia locality's premium reflects the metro's wage and rent levels, which lead the state by a wide margin. For patients, the key locality question in Pennsylvania is simply whether care happens in the Philadelphia area.
Philadelphia is one of America's historic centers of academic medicine, dense with teaching hospitals, while Pittsburgh is dominated by a pair of large integrated systems whose rivalry has defined that market for years. The rural middle of the state, sometimes called the T, has far fewer options, and hospital closures there have drawn statewide attention. Residents near the edges use New York, Baltimore, or Ohio providers when convenient.
Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
Pennsylvania payment localities (GPCI)
| Locality | Work | PE |
|---|---|---|
| metropolitan philadelphia | 1.018 | 1.041 |
| rest of pennsylvania | 1.000 | 0.918 |
GPCI of 1.000 equals the national average. Higher PE GPCI raises office-based procedures more than hospital physician lines.
Featured physician rates in Pennsylvania
Office (non-facility) physician rates. Open a row for the locality table and ZIP tool.
Other states
Medical costs in Pennsylvania: questions
Across the 59 featured procedures on this page, Pennsylvania sits near the national average. Examples: incision & drainage of abscess $128, skin biopsy (tangential) $94, skin biopsy (punch) $120. Search any other CPT in the box above — those codes are in the tool, not as extra Pennsylvania articles.
Pennsylvania has 2 payment localities. Practice-expense GPCI runs from 0.918 to 1.041 (1.000 is the national average). Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
Medicare physician allowed amounts only — the professional fee after GPCI. They do not include hospital facility charges, anesthesia, or your plan’s contracted rate. Medicare patients typically owe 20% of the allowed amount after the Part B deductible, before Medigap.
Yes. The table is the featured set (59 procedures). The search box looks up 7,500+ payable codes from the 2026 fee schedule and applies Pennsylvania’s locality when you enter a ZIP.