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Biopsy of Upper Throat Behind the Nose

Alabama rates for HCPCS 42804

This procedure takes a small tissue sample from the upper part of the throat located behind the nose, using an indirect technique such as a small scope or mirror rather than a larger open surgical approach. It is used to investigate symptoms such as nasal blockage, bleeding, or a visible growth in this area. The tissue sample is examined in a laboratory to check for infection, inflammation, or abnormal cells.

Rates data updated October 2026.

How much does Biopsy of Upper Throat Behind the Nose cost?

$1,568

Typical total for the visit. In Alabama, October 2026.

Insurers have agreed to pay about $1,568 for this procedure. That total is two separate charges: $219 to the doctor who performs it, and $1,349 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

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 4 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$219$135 to $245
Facility feeThe hospital or surgery center$1,349$1,288 to $1,349

How much rates vary

Facilitymedian $1,349 · 10th to 90th $562 to $2,042Professionalmedian $219 · 10th to 90th $110 to $417
$100$200$500$1K$2K$5Kfacility $1,349professional $219

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$562.34
Median
$954.99
Typical High
$2,398.83
Aetna
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$245.47
Typical High
$416.87
BCBS Alabama
Setting
Facility
Modifier
None
Typical Low
$1,318.26
Median
$1,348.96
Typical High
$1,348.96
BCBS Alabama
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$1,412.54
Typical High
$1,737.80
Cigna
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$186.21
Typical High
$295.12
United
Setting
Facility
Modifier
None
Typical Low
$467.74
Median
$1,000.00
Typical High
$3,235.94
United
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$162.18
Typical High
$263.03
7 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$123.03
Median
$123.03
Typical High
$208.93
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$48.98
Median
$48.98
Typical High
$83.18
Aetna
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$186.21
Median
$186.21
Typical High
$316.23
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$37.15
Median
$37.15
Typical High
$63.10
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$24.55
Median
$24.55
Typical High
$41.69
Aetna
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$173.78
Median
$173.78
Typical High
$295.12
BCBS Alabama
Setting
Professional
Modifier
32 · Mandated service
Typical Low
$144.54
Median
$199.53
Typical High
$295.12

Where Alabama sits

The same service costs 9.8 times more in Colorado than in North Dakota. 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.

Physician feeFacility fee

Alabama· 30th of 51

$1,568

$219 physician + $1,349 facility

CO $4,589ND $469

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.