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Biopsy of Upper Throat Behind the Nose

Massachusetts 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?

$1,507

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

Insurers have agreed to pay about $1,507 for this procedure. That total is two separate charges: $219 to the doctor who performs it, and $1,288 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 9 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$219$141 to $316
Facility feeThe hospital or surgery center$1,288$191 to $2,818

How much rates vary

Facilitymedian $1,288 · 10th to 90th $148 to $5,012Professionalmedian $219 · 10th to 90th $117 to $525
$100$200$500$1K$2K$5K$10Kfacility $1,288professional $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
$204.17
Median
$2,238.72
Typical High
$4,168.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$380.19
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$3,630.78
Typical High
$19,498.45
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$251.19
Typical High
$1,548.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$338.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$457.09
Typical High
$1,659.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$478.63
Typical High
$3,090.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$245.47
Typical High
$512.86
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$3,311.31
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$302.00
Typical High
$446.68
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$3,162.28
Typical High
$8,511.38
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$263.03
Typical High
$537.03
Health New England
Setting
Facility
Modifier
Global
Typical Low
$6,165.95
Median
$6,165.95
Typical High
$6,165.95
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$3,630.78
Typical High
$19,498.45
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$251.19
Typical High
$1,548.82
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$3,548.13
Typical High
$8,511.38
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$269.15
Typical High
$562.34

Where Massachusetts 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

Massachusetts· 32nd of 50

$1,507

$219 physician + $1,288 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.