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Biopsy of Upper Throat Behind the Nose

Connecticut 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 October 2026.

How much does Biopsy of Upper Throat Behind the Nose cost?

$3,824

Typical total for the visit. In Connecticut, October 2026.

Insurers have agreed to pay about $3,824 for this procedure. That total is two separate charges: $275 to the doctor who performs it, and $3,548 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 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$275$195 to $380
Facility feeThe hospital or surgery center$3,548$1,660 to $5,012

How much rates vary

Facilitymedian $3,548 · 10th to 90th $759 to $6,918Professionalmedian $275 · 10th to 90th $151 to $537
$100$200$500$1K$2K$5K$10Kfacility $3,548professional $275

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$3,235.94
Median
$4,570.88
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$194.98
Typical High
$295.12
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$3,548.13
Median
$4,168.69
Typical High
$7,943.28
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$302.00
Typical High
$537.03
Cigna
Setting
Facility
Modifier
None
Typical Low
$549.54
Median
$3,019.95
Typical High
$3,801.89
Cigna
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$223.87
Typical High
$338.84
ConnectiCare
Setting
Facility
Modifier
None
Typical Low
$331.13
Median
$446.68
Typical High
$562.34
ConnectiCare
Setting
Professional
Modifier
None
Typical Low
$257.04
Median
$331.13
Typical High
$371.54
United
Setting
Facility
Modifier
None
Typical Low
$660.69
Median
$2,691.53
Typical High
$7,413.10
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$223.87
Typical High
$524.81
6 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$66.07
Median
$89.13
Typical High
$147.91
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$26.30
Median
$35.48
Typical High
$58.88
Aetna
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$100.00
Median
$134.90
Typical High
$218.78
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.95
Median
$26.92
Typical High
$43.65
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$13.18
Median
$17.78
Typical High
$29.51
Aetna
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$93.33
Median
$125.89
Typical High
$204.17

Where Connecticut sits

The same service costs 9.8 times more in Colorado than in North Dakota. 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

Connecticut· 3rd of 51

$3,824

$275 physician + $3,548 facility

CO $4,589ND $469

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.