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Biopsy of Upper Throat Behind the Nose

New York 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.

Facilitymedian $3,548 · 10th–90th $200$8,3180%5%10th90th$3,548Professionalmedian $209 · 10th–90th $120$4790%5%10%10th90th$209$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$2,754.23
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$194.98
Typical High
$331.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$4,786.30
Typical High
$9,120.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$177.83
Typical High
$416.87
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$1,258.93
Typical High
$4,073.80
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$3,715.35
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$245.47
Typical High
$645.65
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$131.83
Typical High
$302.00
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$323.59
Typical High
$489.78
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$245.47
Typical High
$457.09
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$363.08
Typical High
$562.34
United
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$3,467.37
Typical High
$8,128.31
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$316.23
Typical High
$524.81
Univera
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$478.63
Univera
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$257.04
Typical High
$457.09