Exchange Of Prosthetic Lens in Pennsylvania · the short answer
Medicare pays $666.10 on average for exchange of prosthetic lens in Pennsylvania, 7% above the $621.63 national average across all states.
- $666.10
- PA Medicare avg
- $621.63
- National Medicare avg
- 7% above
- vs. national average
State and national averages are computed directly from CMS Medicare Physician & Other Practitioners claims data, 2023.
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
Top Providers in Pennsylvania
| Provider | Medicare | Services |
|---|---|---|
| Main Line Surgery Center, Llc | $580.57 | 108 |
| Gupta, Omesh MD | $674.89 | 28 |
| Plymouth Meeting Ambulatory Surgical Center Llc | $747.20 | 22 |
| Tri County Surgery Center Llc | $864.22 | 17 |
| Warminster Ambulatory Surgical | $432.11 | 12 |
| The Physicians' Surgery Center Lancaster General, Llc | $484.48 | 12 |
Pennsylvania Pricing in Context
In Pennsylvania, CPT code 66986 (Exchange Of Prosthetic Lens) carries an average Medicare payment of $666.10 - 7% above the national benchmark of $621.63. 179 providers across the state submitted claims for this procedure in 2023, performing 748 total services. Payment ranges by individual claim are not published in this CMS extract; the state average above is the figure to compare against the national benchmark.
The average billed charge in Pennsylvania is $2,749.69, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount, the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because Pennsylvania sits above the national Medicare average, commercial rates in the state may also run higher than the US median.
Using RAND 2024 commercial-to-Medicare ratios for Eye Surgery procedures, the estimated commercial insurance price in Pennsylvania lands near $1,844.78, with self-pay cash prices typically around $1,385.07. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.
Frequently Asked Questions
How much does Exchange Of Prosthetic Lens cost in Pennsylvania?
The average Medicare payment for Exchange Of Prosthetic Lens in Pennsylvania is $666.10, which is 7% above the national average of $621.63. Providers in PA typically bill $2,749.69 for this procedure.
What does Exchange Of Prosthetic Lens cost with insurance in Pennsylvania?
With commercial insurance in Pennsylvania, Exchange Of Prosthetic Lens costs an estimated $1,844.78. Without insurance, the estimated cash price is $1,385.07. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.
How many providers perform Exchange Of Prosthetic Lens in Pennsylvania?
179 providers in Pennsylvania billed Medicare for Exchange Of Prosthetic Lens in 2023, performing 748 total services. The state Medicare average for this code is $666.10.
Is Exchange Of Prosthetic Lens cheaper in Pennsylvania than the national average?
No - Exchange Of Prosthetic Lens costs 7% above the national average in Pennsylvania. The state average Medicare payment is $666.10 compared to $621.63 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.
Related Guides
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.