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Biopsy of Upper Throat Behind the Nose

Indiana 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?

$6,340

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

Insurers have agreed to pay about $6,340 for this procedure. That total is two separate charges: $174 to the doctor who performs it, and $6,166 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 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$174$126 to $219
Facility feeThe hospital or surgery center$6,166$2,951 to $8,913

How much rates vary

Facilitymedian $6,166 · 10th to 90th $347 to $10,471Professionalmedian $174 · 10th to 90th $107 to $275
$100$200$500$1K$2K$5K$10Kfacility $6,166professional $174

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
$134.90
Median
$1,380.38
Typical High
$5,623.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$8,128.31
Typical High
$10,471.29
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$158.49
Typical High
$251.19
CareSource
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$123.03
Typical High
$141.25
CareSource
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$3,467.37
Typical High
$6,456.54
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$288.40

Where Indiana 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

Indiana· 1st of 50

$6,340

$174 physician + $6,166 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.