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Biopsy of Upper Throat Behind the Nose

New Jersey 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?

$6,088

Typical total for the visit. In New Jersey, July 2026.

Insurers have agreed to pay about $6,088 for this procedure. That total is two separate charges: $200 to the doctor who performs it, and $5,888 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 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$200$129 to $245
Facility feeThe hospital or surgery center$5,888$3,981 to $7,762

How much rates vary

Facilitymedian $5,888 · 10th to 90th $372 to $10,715Professionalmedian $200 · 10th to 90th $107 to $407
$100$200$500$1K$2K$5K$10Kfacility $5,888professional $200

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
$281.84
Median
$5,888.44
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$186.21
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$213.80
Typical High
$478.63
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$302.00
Typical High
$446.68
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,760.83
Median
$10,471.29
Typical High
$16,595.87
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$208.93
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$4,897.79
Typical High
$8,511.38
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$380.19

Where New Jersey 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

New Jersey· 2nd of 50

$6,088

$200 physician + $5,888 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.