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Biopsy of Upper Throat Behind the Nose

Kentucky 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?

$2,108

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

Insurers have agreed to pay about $2,108 for this procedure. That total is two separate charges: $158 to the doctor who performs it, and $1,950 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$158$120 to $209
Facility feeThe hospital or surgery center$1,950$1,148 to $2,692

How much rates vary

Facilitymedian $1,950 · 10th to 90th $257 to $3,388Professionalmedian $158 · 10th to 90th $95 to $269
$100$200$500$1K$2K$5Kfacility $1,950professional $158

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
$147.91
Median
$851.14
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$2,137.96
Typical High
$2,951.21
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$144.54
Typical High
$213.80
CareSource
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$128.82
Typical High
$177.83
CareSource
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$194.98
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$213.80
Typical High
$1,047.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$213.80
United
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$2,089.30
Typical High
$4,168.69
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$181.97
Typical High
$302.00

Where Kentucky 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

Kentucky· 22nd of 50

$2,108

$158 physician + $1,950 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.