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Biopsy Of Tissue At The Back Of The Mouth And Throat

Michigan rates for HCPCS 42800

This procedure takes a small tissue sample from the area at the back of the mouth and upper throat, including the tonsils and soft palate region, to be examined under a microscope. It's used to investigate a visible sore, growth, or other abnormality in this area. It's typically a quick procedure done under local or general anesthesia depending on the situation.

Rates data updated July 2026.

How much does Biopsy Of Tissue At The Back Of The Mouth And Throat cost?

$158

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $155 from a physician practice, and about $2,042 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$155$126 to $178
FacilityA hospital or hospital-owned outpatient department$2,042$200 to $3,020

How much rates vary

Facilitymedian $2,042 · 10th to 90th $151 to $4,898Professionalmedian $155 · 10th to 90th $110 to $224
$100$200$500$1K$2K$5Kfacility $2,042professional $155

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$2,041.74
Typical High
$4,897.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$147.91
Typical High
$223.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$102.33
Typical High
$102.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$165.96
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$309.03
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$251.19
Typical High
$4,897.79
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$162.18
Typical High
$269.15
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$478.63
Typical High
$676.08
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$2,089.30
Typical High
$4,570.88
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$251.19

Where Michigan sits

The same service costs 2.1 times more in Minnesota than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Michigan· 36th of 51

$158

MN $302HI $145

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.