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Biopsy of Upper Throat Behind the Nose

Wisconsin 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.

Facilitymedian $3,715 · 10th–90th $158$6,9180%5%10%10th90th$3,715Professionalmedian $219 · 10th–90th $117$6030%10%10th90th$219$50.0$200.0$1.0K$5.0K

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
$138.04
Median
$257.04
Typical High
$1,905.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$380.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$4,786.30
Typical High
$7,413.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$323.59
Typical High
$851.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$691.83
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$363.08
Typical High
$851.14
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$208.93
Typical High
$2,754.23
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$380.19
Typical High
$588.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$208.93
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$436.52
Typical High
$1,621.81
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$275.42
Network Health
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$3,890.45
Typical High
$4,570.88
Network Health
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$371.54
Typical High
$645.65
Quartz
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$389.05
Typical High
$707.95
Quartz
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$7,943.28
Typical High
$7,943.28
Quartz
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$446.68
Typical High
$1,548.82
Security Health
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$812.83
Security Health
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$645.65
Typical High
$1,096.48
United
Setting
Facility
Modifier
Global
Typical Low
$2,754.23
Median
$3,548.13
Typical High
$7,244.36
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$239.88
Typical High
$645.65