Price AtlasInteractive atlas · All states · techysurgeon.comTonsils and adenoids removal (child under 12): what insurers pay
Removal of the tonsils and adenoids in a child younger than 12. Commercial negotiated rates by hospital and market, next to Medicare for the same code.
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CPT 42820: Tonsils and Adenoids Removal (Child Under 12)
1087 hospitals in 79 markets. National Medicare rate $6,048, surgery center $3,026.
| Market | Hospitals | 25th pct | Median | 75th pct | Low–high |
|---|---|---|---|---|---|
| Alabama (statewide) | 13 | $3,621 | $5,284 | $6,376 | $2,722–$10,548 |
| Alaska (statewide) | 3 | — | — | — | $7,458–$14,802 |
| Arizona (statewide) | 8 | $4,349 | $5,026 | $6,335 | $3,789–$11,826 |
| Arkansas (statewide) | 14 | $4,772 | $5,563 | $6,463 | $4,000–$8,177 |
| Atlanta GA | 6 | $5,886 | $5,886 | $5,967 | $5,886–$5,994 |
| Austin TX | 13 | $4,657 | $4,863 | $4,863 | $4,657–$8,651 |
| Boston MA | 11 | $7,066 | $9,188 | $9,816 | $5,897–$11,116 |
| California (statewide) | 53 | $8,084 | $12,852 | $22,386 | $4,678–$22,386 |
| Charlotte NC | 5 | $7,033 | $7,033 | $7,033 | $6,937–$7,033 |
| Chicago IL | 8 | $6,448 | $7,104 | $7,374 | $5,908–$9,148 |
| Cleveland OH | 10 | $4,696 | $6,180 | $7,700 | $3,732–$11,761 |
| Colorado (statewide) | 14 | $6,242 | $7,404 | $10,613 | $4,862–$11,720 |
| Connecticut (statewide) | 1 | — | — | — | $5,370–$5,370 |
| Dallas-Fort Worth TX | 11 | $5,929 | $6,794 | $8,682 | $5,023–$15,034 |
| Denver CO | 15 | $5,618 | $6,239 | $7,010 | $5,182–$7,892 |
| Detroit MI | 15 | $3,067 | $4,597 | $6,008 | $3,067–$9,143 |
| Florida (statewide) | 55 | $7,430 | $7,734 | $8,659 | $6,057–$12,650 |
| Georgia (statewide) | 26 | $5,424 | $5,994 | $8,250 | $3,163–$19,226 |
| Hawaii (statewide) | 3 | — | — | — | $4,765–$7,363 |
| Houston TX | 18 | $4,807 | $4,930 | $8,221 | $4,284–$11,299 |
| Idaho (statewide) | 15 | $5,661 | $5,916 | $11,642 | $4,523–$17,743 |
| Illinois (statewide) | 28 | $5,082 | $7,257 | $8,862 | $3,577–$17,575 |
| Indiana (statewide) | 30 | $9,493 | $14,208 | $21,984 | $4,863–$28,691 |
| Indianapolis IN | 1 | — | — | — | $24,625–$24,625 |
| Iowa (statewide) | 22 | $6,048 | $7,822 | $11,606 | $3,466–$17,965 |
| Kansas (statewide) | 16 | $5,414 | $6,602 | $8,272 | $4,500–$14,802 |
| Kentucky (statewide) | 17 | $4,682 | $7,106 | $7,740 | $3,363–$9,886 |
| Las Vegas NV | 2 | — | — | — | $4,679–$7,622 |
| Los Angeles CA | 17 | $7,805 | $8,431 | $9,517 | $5,080–$20,636 |
| Louisiana (statewide) | 25 | $4,043 | $4,996 | $6,206 | $2,805–$11,434 |
| Maine (statewide) | 16 | $24,240 | $27,510 | $28,142 | $12,636–$35,382 |
| Maryland (statewide) | 1 | — | — | — | $5,285–$5,285 |
| Massachusetts (statewide) | 4 | — | — | — | $5,057–$8,239 |
| Miami-Fort Lauderdale FL | 1 | — | — | — | $11,045–$11,045 |
| Michigan (statewide) | 28 | $4,194 | $5,729 | $5,899 | $3,026–$15,695 |
| Minneapolis-St. Paul MN | 8 | $7,319 | $7,342 | $8,073 | $6,994–$12,734 |
| Minnesota (statewide) | 12 | $9,459 | $15,677 | $18,306 | $3,466–$21,651 |
| Mississippi (statewide) | 15 | $5,412 | $5,774 | $6,827 | $3,047–$10,718 |
| Missouri (statewide) | 18 | $5,472 | $6,292 | $7,731 | $4,671–$10,648 |
| Montana (statewide) | 5 | $11,874 | $12,423 | $13,390 | $6,181–$17,423 |
| Nashville TN | 7 | $4,446 | $4,682 | $6,707 | $3,411–$9,298 |
| Nebraska (statewide) | 14 | $6,216 | $8,645 | $8,886 | $3,725–$18,020 |
| Nevada (statewide) | 5 | $4,679 | $4,679 | $11,590 | $4,679–$13,827 |
| New Hampshire (statewide) | 6 | $9,050 | $12,793 | $18,692 | $4,503–$26,509 |
| New Jersey (statewide) | 23 | $6,864 | $7,770 | $8,786 | $5,950–$12,539 |
| New Mexico (statewide) | 8 | $8,484 | $11,637 | $12,842 | $6,243–$17,093 |
| New York (statewide) | 30 | $7,000 | $7,789 | $11,782 | $5,299–$19,368 |
| New York City | 8 | $6,840 | $7,000 | $7,539 | $5,464–$12,211 |
| North Carolina (statewide) | 6 | $8,439 | $9,221 | $11,988 | $5,724–$14,662 |
| North Dakota (statewide) | 5 | $8,551 | $10,234 | $10,341 | $5,176–$13,380 |
| Ohio (statewide) | 36 | $6,161 | $10,950 | $12,720 | $3,156–$22,754 |
| Oklahoma (statewide) | 11 | $6,309 | $10,057 | $11,646 | $5,268–$14,464 |
| Oregon (statewide) | 7 | $15,149 | $16,655 | $21,964 | $11,429–$26,922 |
| Pennsylvania (statewide) | 36 | $6,436 | $11,438 | $15,567 | $4,096–$26,179 |
| Philadelphia PA | 10 | $5,448 | $6,398 | $7,399 | $5,156–$11,208 |
| Phoenix AZ | 8 | $3,902 | $4,116 | $4,231 | $3,610–$4,231 |
| Pittsburgh PA | 6 | $11,046 | $12,195 | $12,810 | $10,082–$14,890 |
| Portland OR | 9 | $13,160 | $13,160 | $17,193 | $12,227–$17,193 |
| Rhode Island (statewide) | 3 | — | — | — | $9,813–$11,370 |
| Richmond VA | 3 | — | — | — | $7,016–$7,130 |
| Rio Grande Valley TX | 4 | — | — | — | $5,830–$7,693 |
| Salt Lake City UT | 9 | $4,523 | $4,523 | $4,523 | $4,523–$4,523 |
| San Antonio TX | 3 | — | — | — | $4,807–$7,222 |
| San Diego CA | 2 | — | — | — | $13,111–$14,040 |
| San Francisco Bay Area CA | 5 | $8,707 | $8,741 | $11,614 | $6,682–$24,307 |
| Seattle-Tacoma WA | 16 | $14,852 | $16,133 | $20,690 | $13,472–$23,300 |
| South Carolina (statewide) | 19 | $9,522 | $12,061 | $14,219 | $3,005–$14,603 |
| South Dakota (statewide) | 3 | — | — | — | $4,120–$9,052 |
| St. Louis MO | 3 | — | — | — | $2,975–$3,234 |
| Tampa FL | 6 | $7,430 | $7,430 | $8,210 | $7,430–$10,426 |
| Tennessee (statewide) | 21 | $4,418 | $4,614 | $5,662 | $2,965–$12,068 |
| Texas (statewide) | 75 | $5,023 | $5,950 | $7,880 | $3,286–$28,641 |
| Utah (statewide) | 14 | $4,523 | $4,523 | $4,523 | $4,523–$20,344 |
| Vermont (statewide) | 1 | — | — | — | $3,260–$3,260 |
| Virginia (statewide) | 20 | $7,356 | $12,599 | $13,531 | $4,936–$20,062 |
| Washington (statewide) | 11 | $15,232 | $16,943 | $21,244 | $6,033–$30,602 |
| Washington DC | 9 | $5,955 | $5,955 | $5,955 | $5,051–$7,242 |
| West Virginia (statewide) | 10 | $8,609 | $9,930 | $19,304 | $5,015–$39,411 |
| Wisconsin (statewide) | 32 | $7,243 | $7,250 | $9,611 | $4,812–$18,858 |
Lowest and highest 12 hospital medians
| Hospital | Market | Median across insurers | × Medicare | Insurers | File date |
|---|---|---|---|---|---|
| North Alabama Shoals Hospital | Alabama (statewide) | $2,722 | 0.5× | 2 | 2026-07-23 |
| Ochsner Abrom Kaplan Memorial Hospital | Louisiana (statewide) | $2,805 | 0.5× | 1 | 2026-04-01 |
| North Alabama Medical Center | Alabama (statewide) | $2,927 | 0.6× | 1 | 2026-07-23 |
| Livingston Regional Hospital | Tennessee (statewide) | $2,965 | 0.6× | 2 | 2026-04-01 |
| Mercy Hospital Washington | St. Louis MO | $2,975 | 0.5× | 12 | 2026-06-10 |
| Musc Medical Center | South Carolina (statewide) | $3,005 | 0.6× | 1 | 2026-04-01 |
| Holland Hospital | Michigan (statewide) | $3,026 | 0.5× | 3 | 2026-09-21 |
| Ochsner Scott Regional | Mississippi (statewide) | $3,047 | 0.6× | 3 | 2026-04-01 |
| Corewell Health Dearborn Hospital | Detroit MI | $3,067 | 0.5× | 1 | 2026-05-01 |
| Corewell Health Beaumont Grosse Pointe Hospital | Detroit MI | $3,067 | 0.5× | 2 | 2026-05-01 |
| Corewell Health William Beaumont University Hospit | Detroit MI | $3,067 | 0.5× | 2 | 2026-05-01 |
| Corewell Health Wayne Hospital | Detroit MI | $3,067 | 0.5× | 2 | 2026-05-01 |
| Northern Light Blue Hill Memorial Hospital | Maine (statewide) | $28,142 | 4.8× | 2 | 2026-03-30 |
| Northern Light C A Dean Hospital | Maine (statewide) | $28,142 | 4.8× | 2 | 2026-03-30 |
| Northern Light Sebasticook Valley Hospital | Maine (statewide) | $28,142 | 4.8× | 2 | 2026-03-30 |
| Parkview Regional Medical Center | Indiana (statewide) | $28,641 | 4.6× | 1 | 2026-09-01 |
| Parkview Huntington Hospital | Indiana (statewide) | $28,641 | 4.6× | 1 | 2026-09-01 |
| Parkview Hospital | Texas (statewide) | $28,641 | 4.8× | 1 | 2026-09-01 |
| Franciscan Health Crawfordsville | Indiana (statewide) | $28,691 | 4.6× | 3 | 2026-01-01 |
| Mainehealth Waldo Hospital | Maine (statewide) | $29,065 | 5.0× | 1 | 2025-09-09 |
| Northern Light Mayo Hospital | Maine (statewide) | $29,639 | 5.1× | 2 | 2026-03-30 |
| Mary Bridge Children'S Hospital | Washington (statewide) | $30,602 | 4.4× | 5 | 2026-08-27 |
| Mainehealth Lincoln Hospital | Maine (statewide) | $35,382 | 6.1× | 1 | 2025-09-09 |
| Logan Regional Medical Center | West Virginia (statewide) | $39,411 | 6.9× | 1 | 2026-04-01 |
Every hospital is on its state's page (linked in the market table) and in the interactive explorer.
Questions
How much do commercial insurers pay hospitals for tonsils and adenoids removal (child under 12)?
Across 1087 hospitals in 79 markets (metro areas and statewide) that post a usable dollar rate, the median commercial rate for CPT 42820, hospital outpatient is $7,342, 1.2× the same hospital's local Medicare base rate. The middle half of hospitals runs $5,550 to $11,551. Figures are each hospital's median across insurers, from its federal price-transparency file.
What does Medicare pay for tonsils and adenoids removal (child under 12)?
Medicare's national hospital outpatient rate for CPT 42820 is $6,048 and its surgery-center rate is $3,026, before local wage adjustment.
Which hospitals post the lowest and highest commercial rates for tonsils and adenoids removal (child under 12)?
Lowest medians: North Alabama Shoals Hospital ($2,722), Ochsner Abrom Kaplan Memorial Hospital ($2,805), North Alabama Medical Center ($2,927). Highest: Logan Regional Medical Center ($39,411), Mainehealth Lincoln Hospital ($35,382), Mary Bridge Children'S Hospital ($30,602). Coverage: every hospital whose price file we could read.