CPT 42700 Surgery - Digestive
I&d abscess peritonsillar Cost
Body System: Digestive
Medicare Facility Rate
$128
CMS PFS CY2026
Medicare Non-Facility Rate
$199
Office/clinic setting
Hospital Outpatient
$242
OPPS rate
Surgery Center (ASC)
$130
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.63
Work RVU
1.95
Facility PE RVU
0.26
Malpractice RVU
5.96
Total RVU
Frequently Asked Questions
How much does I&d abscess peritonsillar cost?
The Medicare facility rate is $128. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $242. Ambulatory surgery center rate: $130.
How much does I&d abscess peritonsillar 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 $128.