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

Finding the exact cost of a medical procedure in advance can be challenging due to varying prices based on location, provider, insurance, and specific CPT codes. To get an estimate, you can contact your healthcare provider directly, speak with your insurance company, or use online tools. For a specific fee schedule lookup with CPT codes and location, you can use services like Payerprice.

What are CPT codes and why are they important for understanding healthcare costs?

CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial because they directly link to the services performed and are used by insurance companies to determine coverage and reimbursement rates. When looking up costs, using the specific CPT code for your procedure is essential for accuracy.

What is a fee schedule and how does it relate to what I pay?

A fee schedule is a comprehensive list of fees used by healthcare providers and insurance companies to determine the payment for specific medical services or procedures, identified by CPT codes. It outlines the maximum allowed amount an insurer will pay for a service. Your out-of-pocket cost will depend on this schedule, your insurance plan's deductible, copay, and coinsurance after the fee schedule amount is applied.

Why do healthcare costs vary so much between different providers or locations?

Healthcare costs vary widely due to several factors, including negotiated rates between providers and insurance companies, regional differences in the cost of living and labor, the complexity of the service, the type of facility (e.g., hospital vs. outpatient clinic), and whether the provider is in-network or out-of-network. Different providers may also have different overheads and pricing strategies.

Where can I look up specific fee schedules or pricing for medical procedures in my area?

For specific fee schedule information and pricing based on CPT codes and your location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search for costs associated with specific CPT codes in particular geographic areas, helping you get a more accurate understanding of potential expenses. While some general information might be available through other resources, Payerprice specializes in providing detailed, location-specific fee data.

CPT 31267 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, 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.

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 LT - Left side of body
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 31267
Medicaid Fee Schedule	View Medicaid rates for 31267

National average reimbursement for CPT 31267 by major payers:

$383.19

$388.65

$424.32

$461.81

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 31267.

CPT 31267

5 of 25 sample ratesHigher to lower in this preview

Providence Surgery And Procedure Center LLC
WAAmbulatory Surgical Clinic/CenterNPI 1205545860Tax ID 88-1232814
$5,035.00Published rate
Michael Olds
WAOtolaryngology PhysicianNPI 1730130808Tax ID 91-1491167
$667.02Published rate
Proliance Surgeons, Inc., P.S., Proliance Surgeons Three Rivers Ear, Nose And Throat
Proliance Surgeons, Inc., P.S.
WAOtolaryngology PhysicianNPI 1255683959Tax ID 91-1606533
$615.19Published rate
Mark Tseng
Surgical Associates Northwest, PC
WASurgery PhysicianNPI 1669631651Tax ID 91-1996643
$409.57Published rate
Sound Pain Alliance, Mt. Baker Surgery Center
Sound Pain Alliance
WAAmbulatory Surgical Clinic/CenterNPI 1457695116Tax ID 82-3663428
$365.27Published 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 31267 vs. Other Surgical Procedures on the Respiratory System Codes

The CPT 31267 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 31267 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
31225-CPT	High	Removal Of Jaw Bone, Surgery To Remove A Portion Of The Upper Jaw Bone That Is Injured Or Diseased. A Sample May Be Tested To Identify The Disease.
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.
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.
31267-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.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31267. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 31267 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 31267 Fee Schedule

Providence Surgery And Procedure Center LLC

Michael Olds

Proliance Surgeons, Inc., P.S., Proliance Surgeons Three Rivers Ear, Nose And Throat

Mark Tseng

Sound Pain Alliance, Mt. Baker Surgery Center