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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.

How much does Biopsy of Upper Throat Behind the Nose cost?

$448

Typical total for the visit. In North Carolina, July 2026.

Insurers have agreed to pay about $448 for this procedure. That total is two separate charges: $219 to the doctor who performs it, and $229 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 8 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$219$166 to $347
Facility feeThe hospital or surgery center$229$162 to $363

How much rates vary

Facilitymedian $229 · 10th to 90th $120 to $2,138Professionalmedian $219 · 10th to 90th $123 to $513
$100$200$500$1K$2K$5Kfacility $229professional $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
$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

Where North Carolina 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

North Carolina· 46th of 50

$448

$219 physician + $229 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.