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Biopsy of Upper Throat Behind the Nose

Maine 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?

$229

Typical physician fee. In Maine, July 2026.

Insurers have agreed to pay about $229 for this service. Most negotiated rates run $148 to $309.

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.

How much rates vary

Facilitymedian $457 · 10th to 90th $457 to $6,761Professionalmedian $229 · 10th to 90th $129 to $479
$100$200$500$1K$2K$5Kfacility $457professional $229

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$177.83
Typical High
$251.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$239.88
Typical High
$512.86
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$269.15
Typical High
$549.54
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$199.53
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$6,760.83
Median
$6,760.83
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$245.47
Typical High
$446.68

Where Maine sits

The same service costs 2.2 times more in Minnesota than in Kentucky. 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.

Maine· 10th of 51

$229

MN $363KY $166

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.