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Biopsy of Upper Throat Behind the Nose

Delaware 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?

$1,808

Typical total for the visit. In Delaware, July 2026.

Insurers have agreed to pay about $1,808 for this procedure. That total is two separate charges: $186 to the doctor who performs it, and $1,622 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 3 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$186$129 to $234
Facility feeThe hospital or surgery center$1,622$417 to $3,236

How much rates vary

Facilitymedian $1,622 · 10th to 90th $129 to $7,244Professionalmedian $186 · 10th to 90th $115 to $331
$100$200$500$1K$2K$5Kfacility $1,622professional $186

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$3,235.94
Typical High
$7,244.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$331.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,412.54
Typical High
$1,621.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$194.98
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$173.78
Typical High
$275.42

Where Delaware sits

The same service costs 17.1 times more in Indiana than in West Virginia. 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

Delaware· 28th of 50

$1,808

$186 physician + $1,622 facility

IN $6,340WV $370

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.