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Biopsy of Upper Throat Behind the Nose

New Mexico 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?

$458

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

Insurers have agreed to pay about $458 for this procedure. That total is two separate charges: $195 to the doctor who performs it, and $263 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$195$132 to $245
Facility feeThe hospital or surgery center$263$170 to $603

How much rates vary

Facilitymedian $263 · 10th to 90th $129 to $6,166Professionalmedian $195 · 10th to 90th $115 to $331
$50$200$1K$5Kfacility $263professional $195

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
$173.78
Median
$331.13
Typical High
$2,137.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$194.98
Typical High
$331.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$6,165.95
Typical High
$9,772.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$181.97
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$1,659.59
Typical High
$1,659.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$338.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$302.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$218.78
Typical High
$346.74
Providence
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$234.42
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$3,630.78
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$213.80
Typical High
$354.81

Where New Mexico 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 Mexico· 45th of 50

$458

$195 physician + $263 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.