CPT 31242 Surgery - Respiratory

How Much Does Nsl/sinus Ndsc Rf Abltj Pnn Cost?

Also known as: Nsl/sinus ndsc rf abltj pnn (CPT 31242)

Nsl/sinus Ndsc Rf Abltj Pnn (CPT 31242) costs $135 at Medicare rates. Hospital outpatient rate: $6.

Cost Comparison by Payer

How much Nsl/sinus ndsc rf abltj pnn costs across different settings and payers

Medicare
Facility rate
$135
Hospital Outpatient
OPPS rate
$6
Surgery Center
ASC rate
$4
Medicare (Facility)
$135
CMS PFS 2026 national rate
Medicare (Office/Clinic)
$2,396
Non-facility setting
Hospital Outpatient
$6
OPPS rate
Surgery Center (ASC)
$4
Ambulatory surgery center

Procedures Commonly Done Together

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How to Reduce Your Cost for Nsl/sinus ndsc rf abltj pnn

Practical tips that can save you hundreds or thousands of dollars

  • 1
    Ask about cash-pay discounts

    Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.

  • 2
    Compare facility vs. office setting costs

    For this procedure, the office rate ($2,396) differs from the facility rate ($135). Ask if it can be done in an office setting.

  • 3
    Shop around — costs vary significantly

    Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.

  • 4
    Check ambulatory surgery centers (ASCs)

    This procedure is available at ASCs for $4, compared to $6 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.

How is the Price Calculated?

Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.

2.63
Work RVU
1.02
Practice Expense RVU
0.39
Malpractice RVU
71.72
Total RVU

Payment = Total RVU (71.72) x CF ($33.40) = $2,395

Frequently Asked Questions

How much does Nsl/sinus ndsc rf abltj pnn cost?

The Medicare facility rate for Nsl/sinus ndsc rf abltj pnn is $135. In a hospital outpatient setting, the rate is $6. At an ambulatory surgery center, the rate is $4. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).

How much does Nsl/sinus ndsc rf abltj pnn cost without insurance?

Without insurance, the cost of Nsl/sinus ndsc rf abltj pnn can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.

Does insurance cover Nsl/sinus ndsc rf abltj pnn?

Most commercial health insurance plans and Medicare cover Nsl/sinus ndsc rf abltj pnn when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.

Why does the cost vary so much by location?

Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.

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