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Biopsy of Upper Throat Behind the Nose

North Carolina 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.

Facilitymedian $229 · 10th–90th $120$2,1380%5%10%10th90th$229Professionalmedian $219 · 10th–90th $123$5130%10%10th90th$219$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$398.11
Typical High
$5,495.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$208.93
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,230.27
Typical High
$1,380.38
BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$251.19
Typical High
$562.34
Cigna
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$1,621.81
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$223.87
Typical High
$426.58
Medcost
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Medcost
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$346.74
Medcost
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$512.86
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$2,398.83
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$177.83
Typical High
$316.23
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$8,317.64
Median
$8,317.64
Typical High
$19,498.45
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,819.70