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Biopsy of Upper Throat Behind the Nose

Illinois 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?

$1,585

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

Insurers have agreed to pay about $1,585 for this procedure. That total is two separate charges: $204 to the doctor who performs it, and $1,380 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 6 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$204$132 to $263
Facility feeThe hospital or surgery center$1,380$537 to $3,236

How much rates vary

Facilitymedian $1,380 · 10th to 90th $204 to $5,370Professionalmedian $204 · 10th to 90th $117 to $380
$100$200$500$1K$2K$5K$10Kfacility $1,380professional $204

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
$204.17
Median
$1,258.93
Typical High
$5,370.32
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$363.08
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$4,073.80
Typical High
$5,623.41
BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$1,000.00
Typical High
$2,691.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$213.80
Typical High
$398.11
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$323.59
Typical High
$741.31
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$151.36
Typical High
$281.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$2,818.38
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$354.81

Where Illinois 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

Illinois· 31st of 50

$1,585

$204 physician + $1,380 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.