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Biopsy of Upper Throat Behind the Nose

Virginia 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?

$444

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

Insurers have agreed to pay about $444 for this procedure. That total is two separate charges: $204 to the doctor who performs it, and $240 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 8 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$204$138 to $257
Facility feeThe hospital or surgery center$240$148 to $1,950

How much rates vary

Facilitymedian $240 · 10th to 90th $126 to $5,248Professionalmedian $204 · 10th to 90th $117 to $339
$100$200$500$1K$2K$5K$10Kfacility $240professional $204

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
$213.80
Median
$2,630.27
Typical High
$7,079.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$199.53
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$3,981.07
Typical High
$4,466.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$213.80
Typical High
$363.08
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$131.83
Typical High
$1,288.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$1,288.25
Typical High
$1,584.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$204.17
Typical High
$380.19
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$263.03
Typical High
$426.58
Medcost
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$295.12
Typical High
$316.23
Medcost
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$213.80
Typical High
$371.54
Medcost
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$478.63
Sentara
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$870.96
Sentara
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$251.19
Typical High
$933.25
United
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$2,818.38
Typical High
$5,754.40
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$186.21
Typical High
$331.13

Where Virginia 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

Virginia· 48th of 50

$444

$204 physician + $240 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.