go back

Biopsy of Upper Throat Behind the Nose

Washington 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?

$613

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

Insurers have agreed to pay about $613 for this procedure. That total is two separate charges: $224 to the doctor who performs it, and $389 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 10 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$224$166 to $331
Facility feeThe hospital or surgery center$389$257 to $2,291

How much rates vary

Facilitymedian $389 · 10th to 90th $166 to $8,511Professionalmedian $224 · 10th to 90th $120 to $525
$50$200$1K$5K$20Kfacility $389professional $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
$239.88
Median
$575.44
Typical High
$11,481.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$208.93
Typical High
$524.81
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$5,495.41
Median
$10,000.00
Typical High
$17,782.79
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$302.00
Typical High
$478.63
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$501.19
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$263.03
Typical High
$549.54
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$302.00
Typical High
$2,818.38
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$275.42
Typical High
$575.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$81.28
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$380.19
Typical High
$436.52
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$1,862.09
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$537.03
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$5,888.44
Median
$9,549.93
Typical High
$17,378.01
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$316.23
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$9,549.93
Typical High
$18,620.87
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$234.42
Typical High
$446.68
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$223.87
Typical High
$316.23

Where Washington 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

Washington· 39th of 50

$613

$224 physician + $389 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.