CPT 43425 Surgery - Digestive
Repair esophagus opening Cost
Body System: Digestive
Medicare Facility Rate
$1,376
CMS PFS CY2026
Medicare Non-Facility Rate
$1,376
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
24.41
Work RVU
10.62
Facility PE RVU
6.16
Malpractice RVU
41.19
Total RVU
Frequently Asked Questions
How much does Repair esophagus opening cost?
The Medicare facility rate is $1,376. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Repair esophagus opening 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 $1,376.