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

To find out the cost of a specific medical procedure, it's best to take a few steps. First, contact your insurance provider to understand your coverage, deductible, copay, and coinsurance. They can often provide an estimated cost based on your plan. Second, you can directly ask your healthcare provider's billing department for an estimate. For a more direct way to look up prices based on standard procedure codes (CPT codes) and your specific location, you can use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows you to search with a CPT code and location to get transparency into potential costs.

What is a CPT code and how does it relate to medical billing?

CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, healthcare providers, and payers to describe medical, surgical, and diagnostic services. They standardize the reporting of medical procedures and services, making it easier for healthcare providers to bill and for insurance companies to process claims. When you look up the cost of a procedure, knowing its CPT code can be very helpful as tools like Payerprice use these codes to provide specific pricing information for your area.

Why do prices for the same medical procedure vary so much?

Prices for the same medical procedure can vary significantly due to several factors. These include the healthcare facility (e.g., hospital vs. outpatient clinic), geographic location, the specific physician or provider, the negotiated rates with different insurance companies, and even whether the service is 'in-network' or 'out-of-network' for your insurance plan. Additionally, a patient's individual insurance benefits, such as their deductible and copay, will affect their out-of-pocket costs. Tools like Payerprice can help you compare these varying costs for specific CPT codes in different locations.

What does 'in-network' vs. 'out-of-network' mean for my medical costs?

'In-network' refers to healthcare providers or facilities that have a contract with your health insurance plan to provide services at pre-negotiated rates. When you use an in-network provider, you typically pay less out-of-pocket because your insurer covers a larger portion of the cost. 'Out-of-network' providers or facilities do not have a contract with your insurance plan. While your plan might still cover some of the cost, you will generally pay a higher percentage of the bill, and the amount applied to your deductible may be different or non-existent. It's crucial to understand this distinction to manage your healthcare expenses.

What is a fee schedule and how can it help me understand healthcare costs?

A fee schedule is a comprehensive list of fees used by insurance companies and healthcare providers to establish payment for various medical services and procedures. It outlines the maximum allowable reimbursement amount for each specific CPT code. Understanding a fee schedule can help you gauge what your insurance company deems as a 'reasonable and customary' charge for a service. While individual patient costs depend on their specific insurance plan, a fee schedule provides a baseline for pricing. Tools such as Payerprice utilize fee schedule data, allowing users to look up costs by CPT code and location, providing valuable insight into the expected charges for services.

CPT 11400 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include 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), and 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.

Exc Tr Ext B9 Marg 0 5 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 0 5 Cm Or Less

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Integumentary System
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None 59 - Distinct Procedural Service 51 - Multiple procedures
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 11400
Medicaid Fee Schedule	View Medicaid rates for 11400

National average reimbursement for CPT 11400 by major payers:

$138.97

$155.59

$164.95

$139.48

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CPT 11400

5 of 25 sample ratesHigher to lower in this preview

Franciscan Surgery Center, LLC
INAmbulatory Surgical Clinic/CenterNPI 1184601098Tax ID 35-2128334
$3,968.00Published rate
El Paso Center For Gastrointestinal Endoscopy, LLC
El Paso Center For Gastrointestinal Endoscopy LLC
TXAmbulatory Surgical Clinic/CenterNPI 1326114869Tax ID 20-1482218
$1,158.00Published rate
Lincoln Endoscopy Center, LLC
Lincoln Endoscopy Center LLC
NEAmbulatory Surgical Clinic/CenterNPI 1992741300Tax ID 47-0807741
$569.00Published rate
Desert View Endoscopy Center, LLC.
Desert View Endoscopy Center LLC
CAAmbulatory Surgical Clinic/CenterNPI 1316231020Tax ID 27-2420135
$330.00Published rate
John P Lydon Dpm, Bethesda Ambulatory Surgical Center
John P Lydon, Dpm
MDAmbulatory Surgical Clinic/CenterNPI 1619967726Tax ID 52-1248448
$112.00Published 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

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CPT 11400 vs. Other Surgical Procedures on the Integumentary System Codes

The CPT 11400 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. 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 11400 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
11400-CPT	Low	Exc Tr Ext B9 Marg 0 5 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 0 5 Cm Or Less
11401-CPT	Low	Exc Tr Ext B9 Marg 0 6 1 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 0 6 To 1 0 Cm
11402-CPT	Low	Exc Tr Ext B9 Marg 1 1 2 Cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 1 1 To 2 0 Cm
11403-CPT	Moderate	Exc Tr Ext B9 Marg 2 1 3cm, Excision Benign Lesion Including Margins Except Skin Tag Unless Listed Elsewhere Trunk Arms Or Legs Excised Diameter 2 1 To 3 0 Cm

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 11400 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 11400 Fee Schedule

Franciscan Surgery Center, LLC

El Paso Center For Gastrointestinal Endoscopy, LLC

Lincoln Endoscopy Center, LLC

Desert View Endoscopy Center, LLC.

John P Lydon Dpm, Bethesda Ambulatory Surgical Center