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Tonsil and Adenoid Removal, Under Age 12

Maine 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?

$407

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $407 for this service. The price depends on where it is billed: about $372 from a physician practice, and about $6,310 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 6 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$372$324 to $575
FacilityA hospital or hospital-owned outpatient department$6,310$5,248 to $9,120

How much rates vary

Facilitymedian $6,310 · 10th to 90th $3,548 to $13,490Professionalmedian $372 · 10th to 90th $288 to $741
$500$1K$2K$5K$10Kfacility $6,310professional $372

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
$3,548.13
Median
$6,309.57
Typical High
$13,489.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$338.84
Typical High
$707.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$446.68
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$416.87
Typical High
$707.95
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$426.58
Typical High
$741.31
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$6,309.57
Typical High
$13,489.63
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$346.74
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$12,022.64
Median
$12,022.64
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$416.87
Typical High
$933.25

Where Maine 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.

Maine· 34th of 51

$407

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.