How can I find out the cost of a medical procedure?

To find out the estimated cost of a medical procedure, you can start by contacting your insurance provider directly, as they can provide estimates based on your specific plan's coverage. For a more direct and detailed way to look up specific fees based on CPT codes and your location, you can utilize tools like Payerprice. It offers a fee schedule lookup tool that can provide more granular cost information relevant to your situation.

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services performed by physicians and other healthcare professionals. They are essential for accurate medical billing and for understanding the specific services rendered.

Why do medical costs vary so much?

Medical costs can vary significantly due to several factors, including the healthcare provider's negotiated rates with different insurance companies, geographic location, the complexity of the procedure, the type of facility where the service is provided (e.g., hospital vs. outpatient clinic), and whether the provider is in-network or out-of-network for your specific insurance plan. Market competition and operational costs also play a role in these price differences.

What is the difference between a co-pay, deductible, and coinsurance?

These are common terms for out-of-pocket costs in health insurance plans: * **Co-pay:** A fixed amount you pay for a covered health service after you've paid your deductible (though some plans have co-pays that don't apply to the deductible). * **Deductible:** The amount you must pay out-of-pocket for medical services before your insurance company begins to pay its share. * **Coinsurance:** Your share of the cost of a healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service, which you typically pay after you've met your deductible. These three components contribute to your total healthcare expenses.

Where can I find specific fee schedules for medical procedures?

For specific fee schedules based on CPT codes and your location, you can use specialized tools designed for this purpose. Payerprice offers a fee schedule lookup tool that allows users to search with CPT codes and specific locations to get detailed pricing information. This can provide more precise data than general estimates or information from insurance providers alone.

CPT 00811 Fee Schedule

Q: Factors that affect fee schedules

Medicare & Medicaid Rates: Government-set reimbursement amounts. Private Insurance Rates: Negotiated rates between providers and insurance companies. Geographic Location: Costs may be higher in urban areas. Provider Type: Hospital providers may have different rates than private practice.

Last Verified: September 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Anesthesia For Lower Intestina, Anesthesia For Lower Intestinal Endoscopic Procedures Endoscope Introduced Distal To Duodenum Not Otherwise Specified Nterpretation And Report Tery Disease Data Preparation And Transmission A

Key Fact	Detail
Service Type	Anesthesia Anesthesia for Procedures on the Lower Abdomen
Common Place of Service	24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital 11 - Office
Common Modifiers	QZ - CRNA service; without medical direction by a physician QS - Monitored anesthesia care service None
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 00811
Medicaid Fee Schedule	View Medicaid rates for 00811

National average anesthesia conversion factor for CPT 00811 by major payers:

$44.57

$61.64

$55.41

$147.86

Compare published rates across providers.

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CPT 00811

5 of 25 sample ratesHigher to lower in this preview

Michael Pesce
Mercy Health System Corporation
CAAnesthesiology PhysicianNPI 1124016589Tax ID 39-0816848
$385.51Published rate
Stephen Rivoli
FLAnesthesiology PhysicianNPI 1356784524Tax ID 80-0886397
$121.79Published rate
Synergy Anesthesia Ct PLLC
CAAnesthesiology PhysicianNPI 1952017113Tax ID 92-1303042
$102.00Published rate
Sanjai Isaac
Allied Digestive Health, LLC
TXAnesthesiology PhysicianNPI 1639159833Tax ID 46-3915494
$90.00Published rate
Shurea Wilson
Methodist Associates In Healthcare Inc
CAAnesthesiology PhysicianNPI 1033297619Tax ID 23-2678055
$40.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

This code appears in 1 published specialty market.

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CPT 00811 vs. Other Anesthesia for Procedures on the Lower Abdomen Codes

The CPT 00811 code is part of the Anesthesia services used for Anesthesia for Procedures on the Lower Abdomen. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 00811 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
00800-CPT	Low	Anesthe For Procs On Lower Anterio Abdomi Wall; Not Otherw, Anesthesia For Procedures On Lower Anterior Abdominal Wall; Not Otherw
00802-CPT	Moderate	Anesthesia Abdomen Shaping, Anesthesia Services For Surgery To Remove Excess Skin And Reconstruct The Lower Portion Of The Abdominal Wall (Abdominal Apron).
00811-CPT	Low	Anesthesia For Lower Intestina, Anesthesia For Lower Intestinal Endoscopic Procedures Endoscope Introduced Distal To Duodenum Not Otherwise Specified Nterpretation And Report Tery Disease Data Preparation And Transmission A
00812-CPT	Low	Anesthesia For Lower Intestina, Anesthesia For Lower Intestinal Endoscopic Procedures Endoscope Introduced Distal To Duodenum Screening Colonoscopy Nterpretation And Report Tery Disease Data Preparation And Transmission A

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 00811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 00811 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 00811 Fee Schedule

Compare published rates across providers.

Michael Pesce

Stephen Rivoli

Synergy Anesthesia Ct PLLC

Sanjai Isaac

Shurea Wilson