CPT 42955 Surgery - Digestive
Surgical opening of throat Cost
Body System: Digestive
Medicare Facility Rate
$697
CMS PFS CY2026
Medicare Non-Facility Rate
$697
Office/clinic setting
Hospital Outpatient
$1
OPPS rate
Surgery Center (ASC)
$659
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
7.81
Work RVU
11.91
Facility PE RVU
1.14
Malpractice RVU
20.86
Total RVU
Frequently Asked Questions
How much does Surgical opening of throat cost?
The Medicare facility rate is $697. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $1. Ambulatory surgery center rate: $659.
How much does Surgical opening of throat 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 $697.