Price AtlasInteractive atlas · All states · techysurgeon.comWhat the whole balloon sinuplasty costs
Opening a sinus passage with a balloon: maxillary (31295), frontal (31296) or sphenoid (31297). Every bill that usually comes with it, who sends it, and where each number comes from.
Price it for your ZIP, hospital or insurerRates by insurer
Medicare, national amounts, 2026
| Bill | Surgery center | Hospital outpatient |
|---|---|---|
| Facility | $3,105 | $7,210 |
| Surgeon | $135 | $135 |
| Assistant | $22 | $22 |
| Anesthesia | $158 | $158 |
| Before surgery (typical) | $177 | $177 |
| Total | $3,597 | $7,702 |
National Medicare amounts (payment-area and wage adjustments at 1.0). Facility: OPPS Addendum B, July 2026 (national unadjusted rate); local = rate × (0.6 × wage index + 0.4); ASC Addendum AA, July 2026 (national rate); local = rate × (0.5 × wage index + 0.5); device-intensive (J8) codes keep the device portion unadjusted; FY 2026 IPPS final rule CMS-1833-F, Table 5; standard amounts from Tables 1A-1E; local = weight × (labor × wage index + non-labor + capital × wage index^0.6848). Leaves out teaching (IME), safety-net (DSH) and outlier add-ons. Surgeon: CMS Physician Fee Schedule CY2026 (RVU26D). Anesthesia: CMS base units × the CY2026 anesthesia conversion factor, with an assumed case time. An educational estimate, not a quote.
Line by line (surgery center)
- Surgery center facility fee: $3,105. Billed by The surgery center. CMS ASC Addendum AA, July 2026: national rate $3,105.48
- Surgeon, CPT 31295: $135. Billed by The surgeon's group. CMS Physician Fee Schedule CY2026 (RVU26D, Oct 2026 release), facility rate, PFS locality national (GPCI 1.0)
- Assistant surgeon (modifier 80): $22. Billed by The assistant surgeon. Medicare Claims Processing Manual, Ch. 12, §20.4.3: assistant-at-surgery (modifiers 80/81/82) = 16% of the surgeon's fee schedule amount; a PA, NP or CNS assisting (modifier AS) = 85% of that, 13.6%. Indicator from the RVU26D ASST SURG column (0 = only with documented medical necessity, 1 = not paid, 2 = paid).
- Anesthesia, ASA code 00160: $158. Billed by The anesthesia group. CMS anesthesia base units (CY2022 file, unchanged for CY2026) + CY2026 anesthesia conversion factor $20.49754 for the nation (ANES2026, RVU26D). Code mapping is ours, from the ASA code descriptors.
- Consultation visit (new patient): $177. Billed by The surgeon's group. CMS PFS CY2026 (RVU26D), non-facility (office) rate, CPT 99204
Questions
How much does a balloon sinuplasty cost in total, with every bill?
At national Medicare rates for 2026, the whole balloon sinuplasty comes to about $3,597 in a surgery center and about $7,702 in a hospital outpatient, counting the facility, the surgeon, anesthesia and typical care before and after. Commercial plans usually pay more; local rates differ by area.
Why do I get separate bills for a balloon sinuplasty?
The surgery center bills for the facility; the surgeon's group bills for the operation (Surgeon, CPT 31295, about $135 from Medicare nationally); the anesthesia group bills by base units plus time (about $158 at our default time); labs, imaging, pathology and therapy each come from their own provider.
What does the surgeon's fee include?
Same-day global: covers the procedure day only.