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Tonsil and Adenoid Removal, Under Age 12

Delaware rates for HCPCS 42820

This surgery removes both the tonsils and adenoids, tissues at the back of the throat and behind the nose that can become chronically infected or enlarged enough to block breathing or cause repeated infections. This version applies to children younger than 12 years old. It's one of the most common surgeries performed on children.

Rates data updated July 2026.

How much does Tonsil and Adenoid Removal, Under Age 12 cost?

$331

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $331 for this service. The price depends on where it is billed: about $309 from a physician practice, and about $5,248 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$309$288 to $427
FacilityA hospital or hospital-owned outpatient department$5,248$3,090 to $6,457

How much rates vary

Facilitymedian $5,248 · 10th to 90th $288 to $7,413Professionalmedian $309 · 10th to 90th $269 to $646
$500$1K$2K$5K$10Kfacility $5,248professional $309

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
Facility
Modifier
Global
Typical Low
$288.40
Median
$5,248.07
Typical High
$7,413.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$309.03
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$2,290.87
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$346.74
Typical High
$537.03
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,495.41
Median
$7,585.78
Typical High
$13,182.57
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$1,000.00
Typical High
$1,479.11
United
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$309.03
Typical High
$501.19

Where Delaware sits

The same service costs 4.3 times more in Wyoming than in Delaware. 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.

Delaware· 51st of 51

$331

WY $1,413DE $331

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.