go back

Biopsy of Upper Throat Behind the Nose

Montana 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?

$446

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

Insurers have agreed to pay about $446 for this procedure. That total is two separate charges: $195 to the doctor who performs it, and $251 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 6 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$195$120 to $240
Facility feeThe hospital or surgery center$251$214 to $372

How much rates vary

Facilitymedian $251 · 10th to 90th $158 to $417Professionalmedian $195 · 10th to 90th $112 to $372
$100$500$2K$10K$50Kfacility $251professional $195

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
$112.20
Median
$177.83
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$223.87
Typical High
$524.81
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$331.13
Typical High
$398.11
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$331.13
Typical High
$398.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$239.88
Typical High
$426.58
Providence
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$288.40
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$269.15
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$245.47
Typical High
$380.19

Where Montana 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

Montana· 47th of 50

$446

$195 physician + $251 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.