CPT 42806 Surgery - Digestive
Biopsy of upper nose/throat Cost
Body System: Digestive
Medicare Facility Rate
$129
CMS PFS CY2026
Medicare Non-Facility Rate
$240
Office/clinic setting
Hospital Outpatient
$3
OPPS rate
Surgery Center (ASC)
$1
ASC rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
1.59
Work RVU
2.04
Facility PE RVU
0.22
Malpractice RVU
7.20
Total RVU
Frequently Asked Questions
How much does Biopsy of upper nose/throat cost?
The Medicare facility rate is $129. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $3. Ambulatory surgery center rate: $1.
How much does Biopsy of upper nose/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 $129.