Reddenda · Rate Intelligence · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD

31231 under Horizon Nj in Philadelphia-Camden-Wilmington, PA-NJ-DE-MD

Nasal endoscopy, diagnostic · Local peer median $190.52 · High confidence

• The local peer median for CPT 31231 under Horizon Nj in Philadelphia-Camden-Wilmington, PA-NJ-DE-MD is $190.52, drawn from 1074 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
• The bottom of the local market (P10) is $117 and the top (P90) is $331.04; the median-to-P90 spread is $140.52.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
• The lowest published rate in this market is $65.81; the highest is $996.15.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
• This benchmark is drawn from 1093 individual rate records that Horizon Nj itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
• Medicare's national non-facility rate for CPT 31231 is $193.39, making the Horizon Nj local median 99% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
• 35.1% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate
• A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

Modeled from Horizon Nj's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Horizon Nj to publish this rate. Page generated 2026-08-23 23:55 UTC; the live index is queried in real time on every request.