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Biopsy of Upper Throat Behind the Nose

Iowa 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?

$2,457

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

Insurers have agreed to pay about $2,457 for this procedure. That total is two separate charges: $219 to the doctor who performs it, and $2,239 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$219$166 to $363
Facility feeThe hospital or surgery center$2,239$309 to $4,786

How much rates vary

Facilitymedian $2,239 · 10th to 90th $209 to $7,586Professionalmedian $219 · 10th to 90th $117 to $813
$100$200$500$1K$2K$5K$10Kfacility $2,239professional $219

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
$363.08
Median
$3,388.44
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$208.93
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$3,548.13
Typical High
$3,548.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$316.23
Typical High
$588.84
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$323.59
Typical High
$575.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$316.23
Typical High
$5,623.41
Medica
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$380.19
Typical High
$1,621.81
Midlands
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$416.87
Typical High
$549.54
Midlands
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$3,548.13
Typical High
$3,548.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$380.19
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$5,128.61
Typical High
$8,709.64
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$234.42
Typical High
$467.74
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$288.40
Typical High
$524.81

Where Iowa 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

Iowa· 18th of 50

$2,457

$219 physician + $2,239 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.