go back

Biopsy of Upper Throat Behind the Nose

South Dakota 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?

$493

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

Insurers have agreed to pay about $493 for this procedure. That total is two separate charges: $224 to the doctor who performs it, and $269 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 7 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$224$186 to $339
Facility feeThe hospital or surgery center$269$166 to $468

How much rates vary

Facilitymedian $269 · 10th to 90th $115 to $2,291Professionalmedian $224 · 10th to 90th $117 to $457
$50$100$200$500$1K$2K$5Kfacility $269professional $224

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
$114.82
Median
$2,290.87
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$190.55
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$363.08
Typical High
$645.65
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$234.42
Typical High
$512.86
Medica
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$331.13
Typical High
$1,621.81
Midlands
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$309.03
Typical High
$457.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$407.38
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$269.15
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$251.19
Typical High
$478.63
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$288.40
Typical High
$549.54

Where South Dakota 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 Dakota· 44th of 50

$493

$224 physician + $269 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.