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 comparisonCPT 31257 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.
Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Sphenoidotomy Imary Procedure) Tery Disease Data Preparation And Transmission A
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Respiratory System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 50 - Bilateral Procedure RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 31257 |
| Medicaid Fee Schedule | View Medicaid rates for 31257 |
National average reimbursement for CPT 31257 by major payers:
$614.86
$604.76
$640.95
$729.61
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 31257.
CPT 31257
5 of 25 sample ratesHigher to lower in this preview
Sacramento Midtown Endoscopy Center, LLC
$5,636.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$2,703.00Published rateUpper Valley Surgery Center
$1,802.00Published rateNorth Country Ec LLC, Northeastern New York Surgical Center
North Country Ec LLC
$1,301.00Published rateSushant Tiwari
Deaconess Hospital Inc
$363.42Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
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 proposalCPT 31257 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31257 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 31257 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 |
|---|---|---|
| 31253-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Frontal Sinus Exploration With Removal Of Tissue From Frontal Sinus When Performed Imary Procedure) Tery Disease Data Preparation And Transmission A |
| 31256-CPT | Moderate | Scope Surgery Of Nose Or Sinus, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. The Procedure May Include Draining A Sinus Or Removing Abnormal Tissue Such As Polyps. |
| 31257-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Sphenoidotomy Imary Procedure) Tery Disease Data Preparation And Transmission A |
| 31259-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Sphenoidotomy With Removal Of Tissue From The Sphenoid Sinus Imary Procedure) Tery Disease Data Preparation And Transmission A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31257. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31257 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 31257) and we'll show you how you compare in 15 minutes or less.