CPT 42180 Surgery - Digestive
Repair lac palate<2 cm Cost
Body System: Digestive
Medicare Facility Rate
$169
CMS PFS CY2026
Medicare Non-Facility Rate
$255
Office/clinic setting
Hospital Outpatient
$551
OPPS rate
Surgery Center (ASC)
$295
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
2.49
Work RVU
2.20
Facility PE RVU
0.36
Malpractice RVU
7.63
Total RVU
Frequently Asked Questions
How much does Repair lac palate<2 cm cost?
The Medicare facility rate is $169. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $551. Ambulatory surgery center rate: $295.
How much does Repair lac palate<2 cm cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $169.