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Biopsy of Upper Throat Behind the Nose

Pennsylvania 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.

Facilitymedian $2,692 · 10th–90th $427$8,3180%5%10%10th90th$2,692Professionalmedian $191 · 10th–90th $112$3090%20%10th90th$191$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$2,691.53
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$295.12
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$4,466.84
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$173.78
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$1,995.26
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$354.81
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$309.03
Typical High
$446.68
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$2,137.96
Typical High
$2,570.40
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$213.80
Typical High
$354.81
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$18,620.87
Median
$18,620.87
Typical High
$18,620.87
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$2,398.83
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$204.17
Typical High
$676.08
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$181.97
Typical High
$489.78
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$1,071.52
Typical High
$2,137.96
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$2,570.40
Typical High
$9,772.37
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$177.83
Typical High
$309.03