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Biopsy of Upper Throat Behind the Nose

Colorado 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?

$3,435

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

Insurers have agreed to pay about $3,435 for this procedure. That total is two separate charges: $200 to the doctor who performs it, and $3,236 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$200$132 to $251
Facility feeThe hospital or surgery center$3,236$229 to $5,888

How much rates vary

Facilitymedian $3,236 · 10th to 90th $148 to $8,128Professionalmedian $200 · 10th to 90th $117 to $347
$100$200$500$1K$2K$5K$10Kfacility $3,236professional $200

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
$223.87
Median
$3,981.07
Typical High
$7,585.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$309.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$6,760.83
Typical High
$10,964.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$223.87
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$891.25
Typical High
$1,659.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$218.78
Typical High
$371.54
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$218.78
Typical High
$371.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$223.87
Typical High
$602.56
Select Health
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$234.42
Typical High
$478.63
Select Health
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$134.90
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$3,311.31
Typical High
$6,309.57
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$213.80
Typical High
$371.54

Where Colorado 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

Colorado· 10th of 50

$3,435

$200 physician + $3,236 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.