CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services to entities such as physicians, hospitals, and health insurance companies. They are crucial for accurate billing and processing of claims.

How can I find the cost of a medical procedure?

Finding the exact cost of a medical procedure can be complex due to varying factors like your insurance plan, location, and provider. To get an estimate based on CPT codes and your specific location, you can utilize tools like Payerprice. They offer a fee schedule lookup tool that allows you to search with CPT codes and specific location details to understand potential costs. You should also contact your insurance provider directly for coverage details specific to your plan.

What is the difference between my deductible, copay, and coinsurance?

These are common terms related to how you share the cost of healthcare with your insurance company: * **Deductible:** The amount you must pay out-of-pocket for covered healthcare services before your insurance plan starts to pay. * **Copay (Copayment):** A fixed amount you pay for a covered healthcare service after you've paid your deductible (for some services, you might pay a copay before meeting your deductible). For example, $20 for a doctor's visit. * **Coinsurance:** Your share of the cost of a covered healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service, after you've met your deductible. For example, if your coinsurance is 20% and the allowed amount is $100, you pay $20.

How do I know what my insurance will cover?

The best way to understand your insurance coverage is to review your plan's Summary of Benefits and Coverage (SBC), which provides an easy-to-understand overview of your plan's benefits. You should also contact your insurance provider directly using the number on your insurance card. They can provide specific details on what services are covered, what your out-of-pocket costs will be, and if any pre-authorization is required for specific procedures.

What should I do if I receive a surprise medical bill?

If you receive a medical bill that seems unexpectedly high or for services you believe should be covered, take these steps: 1. **Review the bill carefully:** Check for any errors, duplicate charges, or services you didn't receive. 2. **Contact your insurance company:** Ask them to explain how the bill was processed and what your plan covers. 3. **Contact the provider's billing department:** Inquire about an itemized bill and ask if there are any options for financial assistance or a payment plan. 4. **Understand your rights:** The No Surprises Act protects you from surprise bills in many situations. 5. **Seek assistance:** If needed, you can contact your state's department of insurance or consumer protection agency.

How can I compare prices for medical services in my area?

Comparing prices for medical services can help you make informed decisions. Many factors influence pricing, including the specific provider, facility, and your insurance plan. To get a general idea of pricing for specific CPT codes in your area, you can use tools like Payerprice. They provide a fee schedule lookup tool that allows you to search for service costs based on CPT codes and location. Additionally, contact your insurance company, as they may have tools or resources to help you compare in-network costs.

CPT 31237 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: 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.

Scope Surgery Of Nose Or Sinus, Nose Or Sinus Surgery Aided By A Scope (Endoscopy). The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Removing Excess Tissue Or Cleaning Out The Area.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Respiratory System
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	50 - Bilateral Procedure None 79 - Unrelated procedure - postop period
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 31237
Medicaid Fee Schedule	View Medicaid rates for 31237

National average reimbursement for CPT 31237 by major payers:

$312.98

$359.13

$400.79

$290.15

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 31237.

CPT 31237

5 of 25 sample ratesHigher to lower in this preview

Kathleen Kieran
Seattle Childrens Hospital
WAUrology PhysicianNPI 1801912134Tax ID 91-0564748
$659.59Published rate
Proliance Surgeons, Inc., P.S., Proliance Orthopedic Associates
Proliance Surgeons, Inc., P.S.
WAMulti-Specialty GroupNPI 1932262904Tax ID 91-1606533
$595.55Published rate
Stanley Herschberg, Do, Ps
WAOtolaryngology PhysicianNPI 1689682585Tax ID 91-0937397
$411.00Published rate
Lighthouse Physical Therapy And Sports Medicine, Lighthouse Pt & Sports Medicine
Lighthouse Physical Therapy And Sports Medicine
WAMulti-Specialty GroupNPI 1598364143Tax ID 87-4255859
$353.29Published rate
Highline Internal Medicine Ps
Highline Internal Medicine
WAMulti-Specialty GroupNPI 1407880321Tax ID 20-2626183
$220.58Published 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 31237 vs. Other Surgical Procedures on the Respiratory System Codes

The CPT 31237 code is part of the Surgery services used for Surgical Procedures on the Respiratory 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 31237 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
31233-CPT	Moderate	Nsl/Sins Ndsc Dx Max Sinusc, Nasal/Sinus Endoscopy Diagnostic; With Maxillary Sinusoscopy (Via Inferior Meatus Or Canine Fossa Puncture)
31237-CPT	Moderate	Scope Surgery Of Nose Or Sinus, Nose Or Sinus Surgery Aided By A Scope (Endoscopy). The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Removing Excess Tissue Or Cleaning Out The Area.
31240-CPT	Moderate	Nasal/Sinus Endoscopy, Surgical; W/Biopsy, Polypectomy Or Debridement (Separate Procedure) With Concha Bullosa Resection
31241-CPT	Moderate	Nose Or Sinus Surgery, Nose Or Sinus Surgery Aided By A Scope (Endoscopy) To Treat Excessive Nose Bleeds. The Procedure Includes Closing Off An Artery In The Nasal Passage.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31237. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 31237 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 31237 Fee Schedule

Compare published rates across providers.

Kathleen Kieran

Proliance Surgeons, Inc., P.S., Proliance Orthopedic Associates

Stanley Herschberg, Do, Ps

Lighthouse Physical Therapy And Sports Medicine, Lighthouse Pt & Sports Medicine

Highline Internal Medicine Ps