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Biopsy of Upper Throat Behind the Nose

Ohio 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?

$2,409

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

Insurers have agreed to pay about $2,409 for this procedure. That total is two separate charges: $170 to the doctor who performs it, and $2,239 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$170$126 to $224
Facility feeThe hospital or surgery center$2,239$617 to $4,467

How much rates vary

Facilitymedian $2,239 · 10th to 90th $219 to $10,233Professionalmedian $170 · 10th to 90th $112 to $302
$100$200$500$1K$2K$5K$10Kfacility $2,239professional $170

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
$208.93
Median
$2,089.30
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$309.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$2,187.76
Typical High
$7,943.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$158.49
Typical High
$275.42
CareSource
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$128.82
Typical High
$1,737.80
CareSource
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$363.08
Typical High
$2,398.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$398.11
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$398.11
Typical High
$2,398.83
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$208.93
Typical High
$380.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$63.10
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$5,128.61
Median
$5,128.61
Typical High
$5,128.61
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$208.93
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$2,570.40
Typical High
$6,025.60
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$177.83
Typical High
$309.03

Where Ohio 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

Ohio· 20th of 50

$2,409

$170 physician + $2,239 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.