A Current Procedural Terminology (CPT) code is a five-digit numerical code used by medical professionals to describe medical, surgical, and diagnostic services. These codes are essential for accurate billing and record-keeping in healthcare.

How can I find the cost of a medical procedure or service?

To find the cost of a specific medical procedure or service based on a CPT code and your location, it's best to use specialized tools designed for price transparency. For accurate and specific pricing information, especially for commercial payers, it is recommended to use a tool like Payerprice. Payerprice offers a fee schedule lookup tool that allows you to search with a specific CPT code and your geographic location to get relevant cost estimates. This can help you understand potential out-of-pocket expenses.

What's the difference between pricing data from Payerprice and information from CMS?

CMS (Centers for Medicare & Medicaid Services) primarily provides public data related to Medicare and Medicaid reimbursement rates. While this data can offer a general baseline, it often does not reflect commercial insurance negotiated rates or the actual patient out-of-pocket costs for those with private insurance. Payerprice, on the other hand, offers a fee schedule lookup tool designed to provide more specific and often commercial payer pricing information. This allows users to search with CPT codes and specific locations for more relevant cost estimates across a broader range of insurance types beyond just Medicare and Medicaid.

Why is healthcare pricing so complex and difficult to understand?

Healthcare pricing is notoriously complex due to a multitude of factors. These include the vast number of different insurance plans, the unique negotiated rates between individual providers and various payers, significant geographic variations in cost, the practice of unbundling services, and a general lack of standardized price transparency across the entire healthcare system. Tools like Payerprice aim to mitigate this complexity by providing more accessible and specific fee schedule data.

How do I use Payerprice to look up pricing information for a medical service?

Payerprice typically offers a user-friendly online tool. To use it, you would generally navigate to their fee schedule lookup tool, input the specific CPT code for the medical service you are interested in, and provide your geographic location (e.g., zip code). The tool then processes this information to provide you with fee schedule data relevant to your search criteria, helping you get an estimate of potential costs. For detailed instructions, it's always best to refer directly to the Payerprice website or their support documentation.

CPT 13101 Fee Schedule

Last Verified: October 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.

Clean And Stitch Wound, Cleaning And Removal Of Damaged Or Infected Tissue For A Wound On The Upper Body. The Wound Is Stitched Closed.

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 79 - Unrelated procedure - postop period
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 13101
Medicaid Fee Schedule	View Medicaid rates for 13101

National average reimbursement for CPT 13101 by major payers:

$447.84

$497.79

$520.71

$431.80

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 13101.

CPT 13101

5 of 25 sample ratesHigher to lower in this preview

Steamboat Surgery Center, LLC
Steamboat Surgery Center LLC
COAmbulatory Surgical Clinic/CenterNPI 1821642661Tax ID 83-4367630
$1,202.00Published rate
Jeffrey Kamenski
COPhysician AssistantNPI 1982983946Tax ID 47-1404474
$510.42Published rate
Elise Bjelica
FLNurse PractitionerNPI 1700328515Tax ID 59-3549147
$335.51Published rate
Madeliene Gainers
MODermatology PhysicianNPI 1679779565Tax ID 39-1351587
$257.10Published rate
Renal Associates, P.A.
Renal Associates, PA
TXAmbulatory Surgical Clinic/CenterNPI 1881125870Tax ID 74-2083988
$79.00Published rate

Get a free rate benchmark for your specialty.

Choose your state and specialty to build a report from payer-published rates.

Build my free benchmark

Use market rates to prepare your payer proposal.

Rate Benchmarking

Compare your rates with similar providers.

Select a published rate, define comparable providers, and see where that rate falls in your market.

See a sample rate comparison

Payer Contract Negotiation

Draft a fee schedule renegotiation letter.

Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.

See a sample payer proposal

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.

Explore state-level rates by specialty

CPT 13101 vs. Other Surgical Procedures on the Integumentary System Codes

The CPT 13101 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 13101 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
12020-CPT	Moderate	Re-Close Surgical Opening, Procedure To Close A Surgical Cut That Has Opened Up. Techniques That May Be Used Include Stitching The Wound Or Inserting A Packing Material For Drainage.
13100-CPT	Moderate	Clean And Stitch Wound, Cleaning And Removal Of Damaged Or Infected Tissue For A Wound On The Upper Body. The Wound Is Stitched Closed.
13101-CPT	Moderate	Clean And Stitch Wound, Cleaning And Removal Of Damaged Or Infected Tissue For A Wound On The Upper Body. The Wound Is Stitched Closed.
13102-CPT	Low	Repair Complex Trunk Each A, Repair Complex Trunk Each Additional 5 Cm Or Less (List Separately In Addition To Code For Primary Procedure)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 13101. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 13101 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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 13101) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo

CPT 13101 Fee Schedule

Compare published rates across providers.

Steamboat Surgery Center, LLC

Jeffrey Kamenski

Elise Bjelica

Madeliene Gainers

Renal Associates, P.A.