Cataract Surgery Cost in Pennsylvania
Xcapsl ctrc rmvl w/o ecp
$2,820Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
Pennsylvania Medicare physician rate (2026)
-0.2% vs nationalAverage of 2 localities. Office range $444.79–$478.80.
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $1,102 on the Medicare allowed amount for cataract surgery. Ask whether your procedure can be done at an ambulatory surgery centre.
Medicare pays the hospital a single comprehensive amount for this procedure, covering the facility's share of the encounter including implants and supplies. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Your ZIP in Pennsylvania
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.
What cataract surgery costs at hospitals near you
Everything above is a national average. The hospital you pick in Pennsylvania moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
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.
National vs Pennsylvania
Where Pennsylvania ranks for this CPT
CPT 66984 by Pennsylvania locality
| Locality | Office |
|---|---|
| metropolitan philadelphia | $478.80 |
| rest of pennsylvania | $444.79 |
PE GPCI ranges from 0.918 to 1.041 in Pennsylvania. That index is why the same CPT is not one price statewide.
Cataract Surgery and how Pennsylvania is priced
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.
This procedure: Cataract surgery removes the eye's clouded natural lens through a tiny incision using ultrasound to break it up, then implants a clear artificial lens called an IOL. It is the most common surgery performed on Medicare patients and one of the safest. Done one eye at a time under numbing drops with light sedation, the procedure itself takes about 15 minutes, and most people notice better vision within days.
What Is Cataract Surgery?
Cataract surgery removes the eye's clouded natural lens through a tiny incision using ultrasound to break it up, then implants a clear artificial lens called an IOL. It is the most common surgery performed on Medicare patients and one of the safest. Done one eye at a time under numbing drops with light sedation, the procedure itself takes about 15 minutes, and most people notice better vision within days.
What Affects the Cost
- –Lens choice is the biggest patient-controlled cost: a standard single-focus lens is covered, while multifocal, extended-depth, or astigmatism-correcting toric lenses cost extra out of pocket, often thousands per eye.
- –Laser-assisted surgery, offered as an upgrade over the standard ultrasound technique, is an additional self-pay charge at many practices.
- –The facility fee differs between hospital outpatient departments and ambulatory surgery centers, where most cataract surgery now happens.
- –Because each eye is a separate surgery weeks apart, all charges effectively occur twice for most patients.
- –Pre-surgical eye measurements and testing beyond the standard set may be billed to you when tied to premium lens upgrades.
Questions to Ask Before Booking
- 1.What exactly is included if I choose the standard covered lens, with zero upgrade charges?
- 2.What is your all-in out-of-pocket price for each premium lens option, per eye?
- 3.Is laser assistance clinically necessary for my eyes or an optional upgrade?
- 4.Where will the surgery be done, and what is the facility fee at that location?
- 5.Does my plan require prior authorization, and is the post-surgery eyeglasses benefit being applied?
Other featured procedures in Pennsylvania
Cataract Surgery in other states
Cataract Surgery in Pennsylvania: questions
The 2026 Medicare physician office rate for CPT 66984 averages $461.80 across 2 Pennsylvania localities, from $444.79 in REST OF PENNSYLVANIA to $478.80 in METROPOLITAN PHILADELPHIA. The hospital physician rate averages $461.80. Enter a ZIP for the exact locality.
Yes. CMS splits Pennsylvania into 2 payment localities. For this CPT the office physician fee spans $34.01 from the lowest to highest locality. 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.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $92 for the office physician line or $92 for the hospital physician line in Pennsylvania. Medigap may cover that 20%. This is not the hospital facility fee.
No. $461.80 is only the physician's share. Adding Medicare's facility payment brings the total to about $2,820 in a hospital outpatient department, or about $1,718 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. Pennsylvania ranks #34 of 51 states on the physician line (within 2% of the national office rate of $462.60).