A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services. They are essential for billing and for tracking healthcare services.

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

To find out the cost of a specific medical procedure or service, you can use the CPT code if you have it. For specific pricing tailored to your location and the service, you can use online tools. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and specific location to find relevant pricing information. You should also contact your insurance provider for your specific out-of-pocket costs and coverage details.

Where can I look up fee schedules for healthcare services?

Fee schedules for healthcare services can often be looked up using specialized tools. For accurate and specific fee schedule information based on CPT codes and your location, Payerprice provides a fee schedule lookup tool. This can help you understand the potential costs before receiving a service.

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

Prices for the same medical service can vary significantly due to several factors, including: Provider differences (hospitals, independent clinics, specialists), geographic location, payer negotiations with providers, facility fees charged by hospitals, and the specific complexity or resources used for the service.

Does my insurance cover a specific CPT code, and what will my out-of-pocket cost be?

To determine if your insurance covers a specific CPT code and what your out-of-pocket cost will be (including deductibles, co-pays, and co-insurance), you should contact your insurance provider directly. They can provide details based on your specific plan benefits, network status of the provider, and whether prior authorization is required. For an estimate of the general cost for a service based on its CPT code and location, Payerprice's fee schedule lookup tool can provide valuable information, which you can then discuss with your insurer.

CPT 21931 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.

Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane 3 Cm Or G, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; 3 Cm Or G

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Musculoskeletal System
Common Place of Service	22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center
Common Modifiers	None 59 - Distinct Procedural Service AS - PA/NP/CNS assistant at surgery
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 21931
Medicaid Fee Schedule	View Medicaid rates for 21931

National average reimbursement for CPT 21931 by major payers:

$634.85

$645.32

$670.07

$783.84

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 21931.

CPT 21931

5 of 25 sample ratesHigher to lower in this preview

Pueblo Ambulatory Surgery Center LLC
COAmbulatory Surgical Clinic/CenterNPI 1639134505Tax ID 62-1488737
$2,388.00Published rate
Sara Scherrer
University Physicians Incorporated
COInfectious Disease PhysicianNPI 1063610939Tax ID 74-2161737
$1,599.36Published rate
Ciara Gyorkos
University Physicians Incorporated
COSurgical Physician AssistantNPI 1700521721Tax ID 74-2161737
$1,474.61Published rate
Kathryn Conyers
University Physicians Incorporated
COAcute Care Nurse PractitionerNPI 1245345511Tax ID 74-2161737
$1,278.00Published rate
Grant Roesler
Deaconess Hospital Inc
OKCertified Registered Nurse AnesthetistNPI 1528019569Tax ID 35-0593390
$373.01Published 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 21931 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 21931 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal 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 21931 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
21920-CPT	Moderate	Biopsy Of Tissue Under Skin, A Procedure To Remove A Sample Of Soft Tissue From Near The Skin Surface For Testing (Biopsy).
21925-CPT	Moderate	Biopsy Back/Flank Deep
21930-CPT	Moderate	Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane Less Than, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; Less Than
21931-CPT	Moderate	Xcision Tumor Sft Tissue Of Bck Or Flank Subcutane 3 Cm Or G, Excision Tumor Soft Tissue Of Back Or Flank Subcutaneous; 3 Cm Or G

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21931. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 21931 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 21931 Fee Schedule

Compare published rates across providers.

Pueblo Ambulatory Surgery Center LLC

Sara Scherrer

Ciara Gyorkos

Kathryn Conyers

Grant Roesler