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Biopsy of Upper Throat Behind the Nose

Georgia 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?

$2,900

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

Insurers have agreed to pay about $2,900 for this procedure. That total is two separate charges: $209 to the doctor who performs it, and $2,692 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 8 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$209$145 to $269
Facility feeThe hospital or surgery center$2,692$1,175 to $4,571

How much rates vary

Facilitymedian $2,692 · 10th to 90th $372 to $6,918Professionalmedian $209 · 10th to 90th $120 to $380
$100$200$500$1K$2K$5K$10Kfacility $2,692professional $209

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
$208.93
Median
$3,548.13
Typical High
$7,585.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$363.08
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$1,949.84
Typical High
$5,248.07
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$251.19
Typical High
$407.38
CareSource
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$645.65
Typical High
$1,862.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$213.80
Typical High
$426.58
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$239.88
Typical High
$416.87
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$2,290.87
Typical High
$5,248.07
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$371.54

Where Georgia 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

Georgia· 13th of 50

$2,900

$209 physician + $2,692 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.