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Biopsy of Upper Throat Behind the Nose

Kansas 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?

$3,053

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

Insurers have agreed to pay about $3,053 for this procedure. That total is two separate charges: $234 to the doctor who performs it, and $2,818 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$234$158 to $347
Facility feeThe hospital or surgery center$2,818$1,096 to $4,074

How much rates vary

Facilitymedian $2,818 · 10th to 90th $447 to $4,074Professionalmedian $234 · 10th to 90th $129 to $933
$200$500$1K$2K$5K$10Kfacility $2,818professional $234

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
$954.99
Median
$3,162.28
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$204.17
Typical High
$346.74
BCBS Kansas
Setting
Facility
Modifier
None
Typical Low
$1,148.15
Median
$3,890.45
Typical High
$4,073.80
BCBS Kansas
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$158.49
Typical High
$275.42
Cigna
Setting
Facility
Modifier
None
Typical Low
$389.05
Median
$1,949.84
Typical High
$1,995.26
Cigna
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$208.93
Typical High
$309.03
Medica
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$891.25
Typical High
$12,022.64
Medica
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$933.25
Typical High
$1,621.81
United
Setting
Facility
Modifier
None
Typical Low
$501.19
Median
$1,047.13
Typical High
$3,388.44
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$199.53
Typical High
$263.03
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
$64.57
Median
$102.33
Typical High
$173.78
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$25.70
Median
$40.74
Typical High
$70.79
Aetna
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$95.50
Median
$154.88
Typical High
$263.03
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.05
Median
$30.90
Typical High
$52.48
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$12.88
Median
$20.42
Typical High
$34.67
Aetna
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$89.13
Median
$144.54
Typical High
$245.47

Where Kansas 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

Kansas· 9th of 51

$3,053

$234 physician + $2,818 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.