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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 July 2026.

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

$4,882

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

Insurers have agreed to pay about $4,882 for this procedure. That total is two separate charges: $204 to the doctor who performs it, and $4,677 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$204$132 to $269
Facility feeThe hospital or surgery center$4,677$3,715 to $6,310

How much rates vary

Facilitymedian $4,677 · 10th to 90th $2,754 to $8,511Professionalmedian $204 · 10th to 90th $115 to $447
$100$200$500$1K$2K$5K$10Kfacility $4,677professional $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
$2,754.23
Median
$4,677.35
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$194.98
Typical High
$371.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,365.16
Typical High
$10,964.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$269.15
Typical High
$501.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$2,818.38
Typical High
$3,981.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$239.88
Typical High
$524.81
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$354.81
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$5,495.41
Typical High
$9,332.54
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$239.88
Typical High
$489.78

Where Connecticut 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

Connecticut· 5th of 50

$4,882

$204 physician + $4,677 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.