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Biopsy of Upper Throat Behind the Nose

Tennessee 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?

$2,434

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

Insurers have agreed to pay about $2,434 for this procedure. That total is two separate charges: $195 to the doctor who performs it, and $2,239 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 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$195$129 to $240
Facility feeThe hospital or surgery center$2,239$1,202 to $3,715

How much rates vary

Facilitymedian $2,239 · 10th to 90th $468 to $6,310Professionalmedian $195 · 10th to 90th $115 to $355
$100$200$500$1K$2K$5K$10Kfacility $2,239professional $195

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
$316.23
Median
$1,479.11
Typical High
$4,073.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$190.55
Typical High
$323.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$3,981.07
Typical High
$5,888.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$223.87
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,659.59
Typical High
$3,019.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$199.53
Typical High
$363.08
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$8,317.64
Median
$19,498.45
Typical High
$19,498.45
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,819.70
Typical High
$1,819.70
United
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$2,137.96
Typical High
$3,715.35
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$186.21
Typical High
$338.84

Where Tennessee 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

Tennessee· 19th of 50

$2,434

$195 physician + $2,239 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.