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Biopsy of Upper Throat Behind the Nose

Florida 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?

$5,068

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

Insurers have agreed to pay about $5,068 for this procedure. That total is two separate charges: $170 to the doctor who performs it, and $4,898 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 7 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$170$123 to $219
Facility feeThe hospital or surgery center$4,898$1,514 to $10,000

How much rates vary

Facilitymedian $4,898 · 10th to 90th $646 to $14,125Professionalmedian $170 · 10th to 90th $105 to $288
$100$1K$10Kfacility $4,898professional $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
$549.54
Median
$3,235.94
Typical High
$11,481.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$173.78
Typical High
$275.42
AvMed
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$2,951.21
Typical High
$10,471.29
AvMed
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$173.78
Typical High
$223.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$977.24
Typical High
$1,659.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$199.53
Typical High
$371.54
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$5,623.41
Median
$12,022.64
Typical High
$23,442.29
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$158.49
Typical High
$251.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$95.50
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$3,090.30
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$169.82
Typical High
$316.23
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$165.96
Typical High
$223.87

Where Florida 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

Florida· 4th of 50

$5,068

$170 physician + $4,898 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.