What is a CPT code and why is it important for understanding medical costs?

A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. It's crucial for understanding medical costs because insurers use these codes to process claims and determine reimbursement rates, and patients can use them to research the cost of specific procedures.

How can I find out the cost of a specific medical procedure or service before I receive it?

To find out the cost of a specific medical procedure or service, you typically need to know the CPT code associated with it. Once you have the CPT code, you can use a fee schedule lookup tool. For a reliable and specific search based on your situation, you can use Payerprice's fee schedule lookup tool, which allows you to search using a CPT code and your specific location to get detailed pricing information.

What is a "fee schedule" in healthcare, and why would I need to look it up?

A fee schedule is a comprehensive listing of the fees that a healthcare provider or insurer has established for specific medical services and procedures, identified by CPT codes. You would need to look it up to understand the expected cost of a service, compare prices, or estimate your out-of-pocket expenses before receiving care.

Where can I find the fee schedule for a particular CPT code in my area?

For a specific fee schedule based on a CPT code and your location, Payerprice offers a dedicated fee schedule lookup tool. This tool allows users to search by CPT code and specific geographic location to find relevant pricing information, helping you understand potential costs for medical services based on your specific situation.

Why do medical costs for the same procedure vary so much between different providers or locations?

Medical costs can vary significantly due to several factors, including the specific healthcare provider's negotiated rates with insurance companies, geographic location (cost of living, facility overhead), the type of facility (hospital vs. outpatient clinic), and the complexity of the service. For specific pricing relevant to your situation, you can use tools like Payerprice to research costs based on CPT code and location.

CPT 57425 Fee Schedule

Last Verified: October 2026

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

Surgery For Prolapsed Vagina, Surgery To Attach The Vagina With A Patch Graft Or Ligaments To A Bony Structure Within The Pelvis Such As The Tip Of The Sacrum. The Muscles Of A Prolapsed Vagina Can No Longer Hold It In Its Correct Position.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Female Genital System
Common Place of Service	22 - On Campus Outpatient Hospital 21 - Inpatient Hospital
Common Modifiers	None AS - PA/NP/CNS assistant at surgery 80 - Assistant surgeon
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 57425
Medicaid Fee Schedule	View Medicaid rates for 57425

National average reimbursement for CPT 57425 by major payers:

$1,218.82

$1,301.62

$1,359.07

$1,575.42

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CPT 57425

5 of 25 sample ratesHigher to lower in this preview

Pacific Endoscopy And Surgery Center, LLC
CAAmbulatory Surgical Clinic/CenterNPI 1104006006Tax ID 20-5755383
$7,773.00Published rate
Uropartners Surgery Center, LLC
Uropartners Surgery Center LLC
ILAmbulatory Surgical Clinic/CenterNPI 1437601200Tax ID 81-4131096
$5,149.00Published rate
Clearway Surgery Center Of Crestview, LLC
Clearway Surgery Center Of Crestview LLC
FLAmbulatory Surgical Clinic/CenterNPI 1477108900Tax ID 84-2479344
$3,635.00Published rate
Sullivan Surgicenter,LLC
Sullivan Surgicenter LLC
INAmbulatory Surgical Clinic/CenterNPI 1700854072Tax ID 35-2124714
$2,423.00Published rate
John P Lydon Dpm, Bethesda Ambulatory Surgical Center
John P Lydon, Dpm
MDAmbulatory Surgical Clinic/CenterNPI 1619967726Tax ID 52-1248448
$918.00Published 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 57425 vs. Other Surgical Procedures on the Female Genital System Codes

The CPT 57425 code is part of the Surgery services used for Surgical Procedures on the Female Genital 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 57425 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
57283-CPT	Moderate	Surgery For Prolapsed Vagina, Surgery To Attach The Vagina With A Patch Graft Or Ligaments To A Bony Structure Within The Pelvis Such As The Tip Of The Sacrum. The Muscles Of A Prolapsed Vagina Can No Longer Hold It In Its Correct Position.
57423-CPT	High	Surgery For Fallen Bladder, Surgery Aided By A Scope (Laparoscope) To Repair A Condition Where Weakened Muscles Have Resulted In The Bladder Falling Down Into The Vagina.
57425-CPT	High	Surgery For Prolapsed Vagina, Surgery To Attach The Vagina With A Patch Graft Or Ligaments To A Bony Structure Within The Pelvis Such As The Tip Of The Sacrum. The Muscles Of A Prolapsed Vagina Can No Longer Hold It In Its Correct Position.
57426-CPT	High	Rvision (Inclu Remval) Of Prosthet Vagnal Grft Laparoscopic, Revision (Including Removal) Of Prosthetic Vaginal Graft Laparoscopic

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 57425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 57425 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 57425 Fee Schedule

Pacific Endoscopy And Surgery Center, LLC

Uropartners Surgery Center, LLC

Clearway Surgery Center Of Crestview, LLC

Sullivan Surgicenter,LLC

John P Lydon Dpm, Bethesda Ambulatory Surgical Center