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Biopsy of Upper Throat Behind the Nose

Oregon 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?

$578

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

Insurers have agreed to pay about $578 for this procedure. That total is two separate charges: $269 to the doctor who performs it, and $309 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$269$200 to $398
Facility feeThe hospital or surgery center$309$204 to $427

How much rates vary

Facilitymedian $309 · 10th to 90th $145 to $525Professionalmedian $269 · 10th to 90th $129 to $550
$100$200$500$1K$2K$5K$10Kfacility $309professional $269

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
$309.03
Median
$575.44
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$213.80
Typical High
$630.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,398.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$295.12
Typical High
$537.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$331.13
Typical High
$524.81
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$234.42
Typical High
$426.58
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$316.23
Typical High
$512.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$380.19
Typical High
$426.58
Providence
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$229.09
Typical High
$426.58
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$316.23
Typical High
$549.54
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$7,413.10
Median
$10,471.29
Typical High
$12,882.50
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$363.08
Typical High
$575.44
United
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$5,495.41
Typical High
$10,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$501.19

Where Oregon 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

Oregon· 41st of 50

$578

$269 physician + $309 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.