How much does cataract surgery cost in Utah? A Utah Department of Health report shows commercial insurance companies allowed a $3,295 median price for cataract surgery between July 2019 and June 2020. Ambulatory Surgery settings allowed amounts were lower (at $2,732) compared to Hospital Outpatient settings ($3,710). That is almost a $1,000 difference between the two. The lowest allowed amount at a location that had at least 100 procedures (on commercially-insured patients) was The SurgiCare Center of Utah (at the Eye Institute). The SurgiCare Center allowed median was $2,659, compared to a median charge of $4,142. The report found median charges could be as high as $16,294, at St. Mark’s Hospital in Millcreek, Utah. But St. Mark’s accepted, on average, a 72% discount off charges. That made St. Mark’s average allowed price $4,563. A charge in the $6,300 range was more common across the 33 locations, with an allowed amount of $3,295. While the difference between charges and allowed amounts results in about a 50% discount, prices varied greatly even within some locations. Discounts vary by insurance plan. The most expensive place was University Hospitals and Clinics, with a median allowed cost of $5,168. Both University Hospital and Mt. Ogden Surgical Center had median charges over $9,000.
Nineteen ambulatory surgery centers and 14 hospital outpatient locations were in the study. CPT code 66984 was used, along with associated anesthesia, surgeon, and procedure costs. Code 66984 covers cataract removal with lens insertion and excludes more complex surgeries. Generally, each surgery is for one eye only. Additional details such as volume, and actual numbers for each provider are in Utah’s OpenData Catalog linked in the report. Medicare patients and quality indicators were not included in the study. Published by the Office of Healthcare Statistics, March 2021.