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Biopsy of Upper Throat Behind the Nose

Rhode Island 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?

$2,757

Typical total for the visit. In Rhode Island, July 2026.

Insurers have agreed to pay about $2,757 for this procedure. That total is two separate charges: $186 to the doctor who performs it, and $2,570 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 4 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$186$148 to $257
Facility feeThe hospital or surgery center$2,570$1,820 to $4,074

How much rates vary

Facilitymedian $2,570 · 10th to 90th $832 to $5,495Professionalmedian $186 · 10th to 90th $117 to $295
$100$200$500$1K$2K$5Kfacility $2,570professional $186

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
$1,513.56
Median
$1,548.82
Typical High
$3,981.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$186.21
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$245.47
Typical High
$363.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$2,570.40
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$3,467.37
Typical High
$6,165.95
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$190.55
Typical High
$323.59

Where Rhode Island 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

Rhode Island· 17th of 50

$2,757

$186 physician + $2,570 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.