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Tonsillectomy (age 12+) in Pennsylvania: what insurers pay

Posted commercial rates at 18 Pennsylvania hospitals, each next to its own Medicare base rate.

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CPT 42826

HospitalMedian across insurers× MedicareInsurersFile date
Upmc Mercy Pittsburgh$2,7160.8×12026-03-06
Upmc East Monroeville$3,5231.1×12026-03-06
Temple University Hospital Philadelphia$5,1641.5×62026-04-13
Jefferson Abington Hospital Abington$5,4821.7×42026-09-15
Upmc Washington Washington$5,6441.8×22026-03-06
Riddle Memorial Hospital Media$5,9341.7×22026-04-01
Paoli Hospital Paoli$6,1871.9×22026-04-01
Jefferson Health-Northeast Philadelphia$6,2341.8×52026-09-15
Jefferson Einstein Montgomery Hospital East Norriton$6,2341.9×52026-09-15
Bryn Mawr Hospital Bryn Mawr$6,2601.8×22026-04-01
Lankenau Medical Center Wynnewood$6,3282.0×22026-04-01
Jefferson Hospital Jefferson Hills$7,6002.4×52026-04-14
Allegheny Valley Hospital Natrona$7,8752.4×52026-04-14
Forbes Hospital Monroeville$8,8922.8×52026-04-14
Ahn Wexford Hospital Wexford$9,4842.9×52026-04-14
Thomas Jefferson University Hospital Philadelphia$9,6302.8×32026-09-15
Allegheny General Hospital Pittsburgh$10,3523.2×52026-04-14
Lehigh Valley Hospital Allentown$12,5303.7×82026-07-01

Questions

How much do insurers pay for tonsillectomy (age 12+) in Pennsylvania?

18 Pennsylvania hospitals post usable commercial rates for tonsillectomy (age 12+) in their federal price-transparency files. For CPT 42826, hospital outpatient, the median across 18 hospitals is $6,247, 1.9× each hospital's local Medicare base rate. Your share depends on your plan's deductible and coinsurance; the surgeon and anesthesia bill separately.