go back

Biopsy of Upper Throat Behind the Nose

Vermont 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?

$200

Typical physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $200 for this service. Most negotiated rates run $129 to $224.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $200 · 10th to 90th $123 to $257
$200$500professional $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
Professional
Modifier
Global
Typical Low
$117.49
Median
$194.98
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$199.53
Typical High
$323.59
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$281.84
Typical High
$512.86
United
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$446.68

Where Vermont sits

The same service costs 2.2 times more in Minnesota than in Kentucky. 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.

Vermont· 39th of 51

$200

MN $363KY $166

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.