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Biopsy of Upper Throat Behind the Nose

Michigan 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?

$2,220

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

Insurers have agreed to pay about $2,220 for this procedure. That total is two separate charges: $178 to the doctor who performs it, and $2,042 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$178$129 to $224
Facility feeThe hospital or surgery center$2,042$2,042 to $4,898

How much rates vary

Facilitymedian $2,042 · 10th to 90th $174 to $5,495Professionalmedian $178 · 10th to 90th $115 to $269
$100$200$500$1K$2K$5K$10Kfacility $2,042professional $178

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
$154.88
Median
$2,041.74
Typical High
$4,897.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$269.15
BCBS
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$398.11
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$602.56
Typical High
$4,897.79
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$309.03
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$524.81
Typical High
$1,122.02
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$3,311.31
Typical High
$8,709.64
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$316.23

Where Michigan 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

Michigan· 21st of 50

$2,220

$178 physician + $2,042 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.