How Much Does Biopsy of Upper Nose/throat Cost?
Also known as: Biopsy of upper nose/throat (CPT 42806)
Biopsy of Upper Nose/throat (CPT 42806) costs $129 at Medicare rates. Hospital outpatient rate: $3.
Cost Comparison by Payer
How much Biopsy of upper nose/throat costs across different settings and payers
Procedures Commonly Done Together
These procedures are frequently performed alongside Biopsy of upper nose/throat
How to Reduce Your Cost for Biopsy of upper nose/throat
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($240) differs from the facility rate ($129). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
- 4 Check ambulatory surgery centers (ASCs)
This procedure is available at ASCs for $1, compared to $3 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (7.20) x CF ($33.40) = $240
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Biopsy of upper nose/throat cost?
The Medicare facility rate for Biopsy of upper nose/throat is $129. In a hospital outpatient setting, the rate is $3. At an ambulatory surgery center, the rate is $1. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Biopsy of upper nose/throat cost without insurance?
Without insurance, the cost of Biopsy of upper nose/throat can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Biopsy of upper nose/throat?
Most commercial health insurance plans and Medicare cover Biopsy of upper nose/throat when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.