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Biopsy of Upper Throat Behind the Nose

Utah 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?

$3,371

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

Insurers have agreed to pay about $3,371 for this procedure. That total is two separate charges: $209 to the doctor who performs it, and $3,162 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$209$141 to $309
Facility feeThe hospital or surgery center$3,162$1,862 to $4,467

How much rates vary

Facilitymedian $3,162 · 10th to 90th $155 to $5,888Professionalmedian $209 · 10th to 90th $115 to $468
$100$200$500$1K$2K$5K$10Kfacility $3,162professional $209

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
$154.88
Median
$3,162.28
Typical High
$4,570.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$208.93
Typical High
$588.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$407.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$398.11
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$4,677.35
Median
$6,309.57
Typical High
$9,772.37
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$257.04
Typical High
$371.54
Select Health
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Select Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$223.87
Typical High
$416.87
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$269.15
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$4,466.84
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$316.23

Where Utah 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

Utah· 11th of 50

$3,371

$209 physician + $3,162 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.