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Biopsy of Upper Throat Behind the Nose

South Carolina 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?

$502

Typical total for the visit. In South Carolina, July 2026.

Insurers have agreed to pay about $502 for this procedure. That total is two separate charges: $200 to the doctor who performs it, and $302 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$200$132 to $251
Facility feeThe hospital or surgery center$302$195 to $4,365

How much rates vary

Facilitymedian $302 · 10th to 90th $141 to $8,913Professionalmedian $200 · 10th to 90th $117 to $331
$100$500$2K$10Kfacility $302professional $200

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
$144.54
Median
$5,623.41
Typical High
$21,877.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$199.53
Typical High
$331.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$4,365.16
Typical High
$7,244.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$162.18
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$436.52
Typical High
$1,819.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$213.80
Typical High
$416.87
Medcost
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$295.12
Typical High
$295.12
Medcost
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$218.78
Typical High
$371.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$6,165.95
Typical High
$10,471.29
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$181.97
Typical High
$323.59

Where South Carolina 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

South Carolina· 43rd of 50

$502

$200 physician + $302 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.