Price Checker / CPT 42804
How much does Biopsy Of Upper Nose/throat cost?
CPT 42804 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is roughly 5.1x the fair price. This is well above fair — push back or dispute it.
Fair price
$320–$650
What this should cost
With insurance
~$2,750
Typical out-of-pocket
Overcharged if over
$810
Push back above this
The average hospital charge of $2,485 is $1,995 over the fair price (about 5.1x the fair rate).
What hospitals charge for Biopsy Of Upper Nose/throat
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Wills Memorial Hospital WASHINGTON, GA | $2,485 | $1,740 | 1053% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About Biopsy Of Upper Nose/throat
CPT code 42804 refers to biopsy of upper nose/throat (billing description: "Biopsy of upper nose/throat"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $113 in a facility (hospital or surgery center) and $215 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.