Price AtlasInteractive atlas · All states · techysurgeon.comTonsillectomy (age 12+): what insurers pay
Tonsil removal, age 12 or over. Commercial negotiated rates by hospital and market, next to Medicare for the same code.
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CPT 42826: Tonsillectomy (Age 12+)
1120 hospitals in 81 markets. National Medicare rate $3,387, surgery center $1,480.
| Market | Hospitals | 25th pct | Median | 75th pct | Low–high |
|---|---|---|---|---|---|
| Alabama (statewide) | 11 | $3,045 | $3,621 | $4,136 | $2,722–$6,376 |
| Alaska (statewide) | 3 | — | — | — | $4,926–$15,698 |
| Arizona (statewide) | 10 | $3,946 | $4,668 | $5,354 | $2,038–$7,469 |
| Arkansas (statewide) | 15 | $2,789 | $3,116 | $3,698 | $1,875–$5,000 |
| Atlanta GA | 6 | $5,024 | $5,024 | $5,890 | $5,024–$6,179 |
| Austin TX | 13 | $2,515 | $5,019 | $5,019 | $2,515–$5,844 |
| Boston MA | 11 | $3,938 | $4,279 | $4,930 | $2,552–$5,606 |
| California (statewide) | 56 | $5,704 | $9,569 | $12,272 | $3,969–$16,606 |
| Charlotte NC | 5 | $3,856 | $3,856 | $3,856 | $3,803–$3,856 |
| Chicago IL | 8 | $4,562 | $5,636 | $7,295 | $3,811–$7,543 |
| Cleveland OH | 11 | $3,426 | $4,052 | $5,034 | $2,694–$6,831 |
| Colorado (statewide) | 14 | $4,864 | $5,372 | $6,879 | $2,214–$10,181 |
| Columbus OH | 1 | — | — | — | $11,925–$11,925 |
| Connecticut (statewide) | 2 | — | — | — | $6,002–$13,814 |
| Dallas-Fort Worth TX | 12 | $5,528 | $5,843 | $6,708 | $5,023–$10,598 |
| Denver CO | 15 | $3,363 | $5,270 | $5,736 | $2,214–$7,526 |
| Detroit MI | 14 | $3,067 | $3,166 | $4,566 | $2,866–$5,812 |
| Florida (statewide) | 58 | $5,432 | $6,965 | $7,522 | $2,087–$15,595 |
| Georgia (statewide) | 28 | $3,815 | $5,226 | $6,179 | $2,439–$17,972 |
| Hawaii (statewide) | 3 | — | — | — | $5,092–$5,324 |
| Houston TX | 19 | $4,608 | $4,807 | $5,172 | $4,254–$6,328 |
| Idaho (statewide) | 15 | $3,044 | $4,103 | $6,902 | $2,743–$12,322 |
| Illinois (statewide) | 30 | $3,823 | $4,935 | $7,295 | $3,044–$9,635 |
| Indiana (statewide) | 30 | $4,603 | $6,318 | $8,212 | $2,274–$23,182 |
| Indianapolis IN | 1 | — | — | — | $13,791–$13,791 |
| Iowa (statewide) | 22 | $3,387 | $4,854 | $6,876 | $2,465–$10,061 |
| Kansas (statewide) | 19 | $3,720 | $4,404 | $5,135 | $2,246–$15,698 |
| Kentucky (statewide) | 18 | $3,966 | $4,510 | $5,344 | $2,709–$8,788 |
| Las Vegas NV | 2 | — | — | — | $3,010–$3,182 |
| Los Angeles CA | 17 | $5,718 | $8,230 | $9,662 | $5,311–$25,517 |
| Louisiana (statewide) | 24 | $2,950 | $3,099 | $3,943 | $2,151–$9,480 |
| Maine (statewide) | 16 | $13,289 | $15,081 | $15,428 | $7,077–$19,397 |
| Maryland (statewide) | 1 | — | — | — | $4,751–$4,751 |
| Massachusetts (statewide) | 5 | $2,552 | $3,639 | $4,358 | $2,532–$4,642 |
| Miami-Fort Lauderdale FL | 1 | — | — | — | $5,546–$5,546 |
| Michigan (statewide) | 30 | $2,805 | $3,224 | $4,020 | $1,854–$5,715 |
| Minneapolis-St. Paul MN | 8 | $4,550 | $4,800 | $4,859 | $2,740–$6,069 |
| Minnesota (statewide) | 12 | $5,012 | $8,602 | $10,058 | $3,466–$11,903 |
| Mississippi (statewide) | 14 | $3,682 | $3,980 | $5,136 | $2,729–$9,812 |
| Missouri (statewide) | 17 | $4,446 | $5,182 | $7,829 | $1,839–$9,202 |
| Montana (statewide) | 6 | $6,538 | $7,155 | $8,028 | $4,054–$9,283 |
| Nashville TN | 8 | $3,658 | $3,910 | $4,508 | $2,307–$6,684 |
| Nebraska (statewide) | 11 | $6,473 | $9,875 | $9,875 | $3,182–$20,585 |
| Nevada (statewide) | 5 | $2,986 | $3,182 | $6,311 | $2,986–$7,744 |
| New Hampshire (statewide) | 6 | $9,065 | $12,224 | $14,384 | $4,503–$14,847 |
| New Jersey (statewide) | 24 | $5,263 | $6,988 | $8,205 | $3,763–$13,320 |
| New Mexico (statewide) | 8 | $5,353 | $7,893 | $10,412 | $2,019–$13,563 |
| New York (statewide) | 29 | $3,996 | $5,470 | $7,302 | $2,531–$10,176 |
| New York City | 8 | $3,542 | $3,830 | $7,101 | $3,542–$11,263 |
| North Carolina (statewide) | 5 | $3,928 | $8,212 | $8,790 | $3,828–$9,044 |
| North Dakota (statewide) | 5 | $5,685 | $5,876 | $7,356 | $5,610–$9,992 |
| Ohio (statewide) | 38 | $3,569 | $6,930 | $9,806 | $1,993–$12,744 |
| Oklahoma (statewide) | 9 | $3,761 | $6,748 | $6,886 | $2,156–$11,390 |
| Oregon (statewide) | 9 | $8,304 | $8,973 | $11,282 | $3,723–$14,848 |
| Pennsylvania (statewide) | 35 | $5,094 | $7,074 | $11,140 | $2,497–$15,942 |
| Philadelphia PA | 11 | $6,060 | $6,328 | $7,967 | $5,164–$13,320 |
| Phoenix AZ | 8 | $3,732 | $3,782 | $3,786 | $3,592–$3,786 |
| Pittsburgh PA | 8 | $3,954 | $6,056 | $6,865 | $2,385–$8,163 |
| Portland OR | 9 | $11,261 | $11,261 | $11,960 | $10,830–$11,960 |
| Research Triangle NC | 1 | — | — | — | $3,175–$3,175 |
| Rhode Island (statewide) | 3 | — | — | — | $6,251–$8,635 |
| Richmond VA | 3 | — | — | — | $6,884–$8,137 |
| Rio Grande Valley TX | 4 | — | — | — | $4,194–$6,736 |
| Salt Lake City UT | 9 | $4,523 | $4,523 | $4,523 | $4,523–$4,523 |
| San Antonio TX | 3 | — | — | — | $4,332–$4,807 |
| San Diego CA | 6 | $7,249 | $7,249 | $7,249 | $6,098–$7,863 |
| San Francisco Bay Area CA | 6 | $7,762 | $8,567 | $9,925 | $7,098–$22,041 |
| Seattle-Tacoma WA | 16 | $9,124 | $9,412 | $11,374 | $8,547–$12,600 |
| South Carolina (statewide) | 19 | $9,488 | $10,678 | $16,082 | $2,685–$20,079 |
| South Dakota (statewide) | 3 | — | — | — | $4,002–$9,052 |
| St. Louis MO | 4 | — | — | — | $2,975–$3,234 |
| Tampa FL | 6 | $6,037 | $6,037 | $6,037 | $4,116–$15,523 |
| Tennessee (statewide) | 22 | $3,163 | $3,565 | $3,926 | $2,434–$6,818 |
| Texas (statewide) | 78 | $3,828 | $5,001 | $5,486 | $2,035–$10,176 |
| Utah (statewide) | 14 | $4,523 | $4,523 | $4,523 | $2,931–$10,840 |
| Vermont (statewide) | 2 | — | — | — | $4,353–$4,528 |
| Virginia (statewide) | 19 | $8,403 | $9,428 | $11,132 | $5,146–$13,623 |
| Washington (statewide) | 11 | $8,978 | $9,560 | $11,728 | $3,317–$16,825 |
| Washington DC | 9 | $5,866 | $5,866 | $5,866 | $5,051–$6,822 |
| West Virginia (statewide) | 9 | $4,583 | $5,538 | $10,778 | $2,708–$22,072 |
| Wisconsin (statewide) | 34 | $5,940 | $7,651 | $7,651 | $2,600–$12,998 |
Lowest and highest 12 hospital medians
| Hospital | Market | Median across insurers | × Medicare | Insurers | File date |
|---|---|---|---|---|---|
| Mercy Hospital Joplin | Missouri (statewide) | $1,839 | 0.6× | 16 | 2026-06-09 |
| Mercy Hospital Springfield | Missouri (statewide) | $1,839 | 0.6× | 18 | 2026-06-04 |
| Oaklawn Hospital | Michigan (statewide) | $1,854 | 0.6× | 2 | 2026-03-27 |
| Mercy Hospital Northwest Arkansas | Arkansas (statewide) | $1,875 | 0.6× | 6 | 2026-06-08 |
| Akron Children'S Hospital | Ohio (statewide) | $1,993 | 0.6× | 1 | 2025-11-11 |
| Cibola General Hospital | New Mexico (statewide) | $2,019 | 0.6× | 1 | 2026-09-27 |
| Ennis Regional Medical Center | Texas (statewide) | $2,035 | 0.6× | 1 | 2026-04-01 |
| Yuma Regional Medical Center | Arizona (statewide) | $2,038 | 0.6× | 2 | 2025-09-30 |
| Henry Ford Health Providence Southfield Hospital | Michigan (statewide) | $2,042 | 0.6× | 1 | 2026-01-01 |
| Henry Ford Genesys Hospital | Michigan (statewide) | $2,071 | 0.6× | 3 | 2026-01-01 |
| Uf Health Leesburg Hospital | Florida (statewide) | $2,087 | 0.6× | 1 | 2026-03-31 |
| Washington Regional Medical Center | Arkansas (statewide) | $2,108 | 0.7× | 13 | 2026-04-01 |
| Mary Bridge Children'S Hospital | Washington (statewide) | $16,825 | 4.3× | 5 | 2026-08-27 |
| Northeast Georgia Medical Center, Inc | Georgia (statewide) | $17,972 | 5.7× | 2 | 2026-04-01 |
| Northeast Georgia Medical Center Habersham | Georgia (statewide) | $17,972 | 6.2× | 2 | 2026-04-01 |
| Northeast Georgia Medical Center Barrow | Georgia (statewide) | $17,972 | 5.4× | 2 | 2026-04-01 |
| Northeast Georgia Medical Center Lumpkin | Georgia (statewide) | $17,972 | 5.4× | 2 | 2026-04-01 |
| Mainehealth Lincoln Hospital | Maine (statewide) | $19,397 | 6.0× | 1 | 2025-09-09 |
| Mcleod Medical Center - Dillon | South Carolina (statewide) | $20,079 | 6.5× | 1 | 2026-07-20 |
| Chi Health St Francis | Nebraska (statewide) | $20,585 | 6.0× | 6 | 2026-02-28 |
| Stanford Health Care | San Francisco Bay Area CA | $22,041 | 4.5× | 3 | 2026-04-01 |
| Logan Regional Medical Center | West Virginia (statewide) | $22,072 | 6.9× | 1 | 2026-04-01 |
| Franciscan Health Lafayette | Indiana (statewide) | $23,182 | 6.6× | 3 | 2026-01-01 |
| Cedars-Sinai Medical Center | Los Angeles CA | $25,517 | 6.0× | 3 | 2025-11-26 |
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 tonsillectomy (age 12+)?
Across 1120 hospitals in 81 markets (metro areas and statewide) that post a usable dollar rate, the median commercial rate for CPT 42826, hospital outpatient is $5,521, 1.6× the same hospital's local Medicare base rate. The middle half of hospitals runs $3,960 to $7,973. Figures are each hospital's median across insurers, from its federal price-transparency file.
What does Medicare pay for tonsillectomy (age 12+)?
Medicare's national hospital outpatient rate for CPT 42826 is $3,387 and its surgery-center rate is $1,480, before local wage adjustment.
Which hospitals post the lowest and highest commercial rates for tonsillectomy (age 12+)?
Lowest medians: Mercy Hospital Joplin ($1,839), Mercy Hospital Springfield ($1,839), Oaklawn Hospital ($1,854). Highest: Cedars-Sinai Medical Center ($25,517), Franciscan Health Lafayette ($23,182), Logan Regional Medical Center ($22,072). Coverage: every hospital whose price file we could read.