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Biopsy of Upper Throat Behind the Nose

Washington, DC 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 July 2026.

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

$200

Typical physician fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $200 for this service. Most negotiated rates run $132 to $257.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $1,698 · 10th to 90th $269 to $7,762Professionalmedian $170 · 10th to 90th $117 to $269
$100$200$500$1K$2K$5K$10Kfacility $1,698professional $170

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
$269.15
Median
$1,698.24
Typical High
$4,073.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$269.15
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$131.83
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$204.17
Typical High
$524.81
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$245.47
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$6,606.93
Typical High
$26,302.68
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$194.98
Typical High
$407.38

Where Washington, DC sits

The same service costs 2.2 times more in Minnesota than in Kentucky. 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.

Washington, DC· 34th of 51

$200

MN $363KY $166

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.