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Tonsils and adenoids removal (child under 12) in Virginia: what insurers pay

Posted commercial rates at 31 Virginia hospitals, each next to its own Medicare base rate.

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CPT 42820

HospitalMedian across insurers× MedicareInsurersFile date
Sentara Martha Jefferson Hospital Charlottesville$4,9360.8×42026-04-01
Spotsylvania Regional Medical Center Fredericksburg$5,4980.9×52026-09-01
Inova Alexandria Hospital Alexandria$5,9551.0×72026-04-01
Inova Loudoun Hospital Leesburg$5,9551.0×72026-04-01
Inova Fairfax Hospital Falls Church$5,9551.0×72026-04-01
Inova Fair Oaks Hospital Fairfax$5,9551.0×72026-04-01
Inova Mount Vernon Hospital Alexandria$5,9551.0×72026-04-01
Sentara Northern Virginia Medical Center Woodbridge$6,7541.1×42026-04-01
CJW Medical Center (Chippenham + Johnston-Willis) Richmond$7,0161.2×62026-09-01
Tricities Hospital Hopewell$7,0511.2×52026-09-01
Augusta Health Fishersville$7,0611.2×32026-04-01
Henrico Doctors' Hospital Richmond$7,1301.2×62026-09-01
Lewisgale Hospital Alleghany Low Moor$7,2081.3×32026-09-01
Reston Hospital Center Reston$7,2421.2×62026-09-01
Stonesprings Hospital Center Dulles$7,2421.2×62026-09-01
Fauquier Hospital Warrenton$7,2681.2×12026-07-14
Lewisgale Hospital Montgomery Blacksburg$7,3861.3×32026-09-01
Riverside Regional Medical Center Newport News$9,0501.6×32026-01-02
Lewisgale Hospital Pulaski Pulaski$9,7521.7×32026-09-01
Lewisgale Medical Center Salem$10,9211.9×22026-09-01
Sentara Obici Hospital Suffolk$12,5992.2×32026-04-01
Sentara Leigh Hospital Norfolk$12,5992.2×32026-04-01
Sentara Princess Anne Hospital Virginia Beach$12,5992.2×32026-04-01
Sentara Virginia Beach General Hospital Virginia Beach$12,6802.2×32026-04-01
Sentara Norfolk General Hospital Norfolk$12,7392.2×32026-04-01
Riverside Doctors' Hospital Of Williamsburg Williamsburg$13,5002.3×12026-01-02
Riverside Shore Memorial Hospital Onancock$13,6232.4×12026-01-02
Sentara Careplex Hospital Hampton$15,9942.8×22026-04-01
Sentara Williamsburg Regional Medical Center Williamsburg$16,8002.9×22026-04-01
Sentara Rmh Medical Center Harrisonburg$18,2153.1×12026-04-01
Sentara Halifax Regional Hospital South Boston$20,0623.5×12026-04-01

Questions

How much do insurers pay for tonsils and adenoids removal (child under 12) in Virginia?

31 Virginia hospitals post usable commercial rates for tonsils and adenoids removal (child under 12) in their federal price-transparency files. For CPT 42820, hospital outpatient, the median across 31 hospitals is $7,268, 1.3× each hospital's local Medicare base rate. Your share depends on your plan's deductible and coinsurance; the surgeon and anesthesia bill separately.