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Biopsy of Upper Throat Behind the Nose

Idaho 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?

$512

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

Insurers have agreed to pay about $512 for this procedure. That total is two separate charges: $224 to the doctor who performs it, and $288 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$224$155 to $324
Facility feeThe hospital or surgery center$288$186 to $776

How much rates vary

Facilitymedian $288 · 10th to 90th $132 to $6,026Professionalmedian $224 · 10th to 90th $123 to $407
$100$200$500$1K$2K$5K$10Kfacility $288professional $224

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
$1,412.54
Median
$4,466.84
Typical High
$7,079.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$199.53
Typical High
$371.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$3,090.30
Typical High
$8,317.64
BCBS
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$288.40
Typical High
$426.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$363.08
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$239.88
Typical High
$489.78
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$239.88
Typical High
$426.58
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$199.53
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$5,248.07
Median
$7,244.36
Typical High
$10,471.29
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$288.40
Typical High
$436.52
Select Health
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$3,548.13
Typical High
$5,754.40
Select Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$199.53
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$6,165.95
Typical High
$7,762.47
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$213.80
Typical High
$363.08

Where Idaho 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

Idaho· 42nd of 50

$512

$224 physician + $288 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.