Insurance programs negotiate rates with providers (Ophthalmologists, Anesthesiologists) and Facilities (Ambulatory Surgery Centers and Hospitals).   One of the most common carriers responsible for reimbursing for cataract surgery is Medicare or Medicare replacement plans.  These plans contract with providers and develop a fee schedule based on various factors including difficulty and time of the procedure, technical expertise, local costs, and malpractice premium costs.  The is a wide range of charges for surgery depending on the provider’s fee schedule and the facility fee schedule.   Despite the range of charges, insurance providers will reimburse the lesser of charged fees or fee schedule rates.    Medicare will only reimburse 80% of their fee schedule amount leaving 20% as the patient’s responsibility.   Many patients obtain “supplement” insurance to cover the non-reimbursed 20% co-pay limiting their out-of-pocket risk.  f On average, insurance carriers may spend between $1,800 and $8,800 per eye for cataract surgery. However, the actual cost can vary based on who performs the surgery, the location of the hospital or surgery center where the surgery takes place, the type of surgery center (corporate, private, affiliation with a hospital, and the classification of the center (as a hospital outpatient department or independent) health insurance, and other available options.  As you can see, there is a wide range of costs and generally a lack of transparency often leaving the underinsured or uninsured patient with significant financial uncertainty and risk if they don’t obtain a binding fee estimate in advance.   The main costs that should be determined in advance are the surgeon’s fee, the anesthesia fee (provided by the surgeon, nurse under the supervision of the surgeon, CRNA, or anesthesiologist), and the type of anesthesia (topical, or even general), the facility fee and the medication fees.   Transportation and fees in the event of a complication can vary as well.