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New York rates for HCPCS 42820

Tonsillectomy and adenoidectomy; younger than age 12

Facilitymedian $6,026 · 10th–90th $550–$11,7490%5%10%10th90th$6,026Professionalmedian $417 · 10th–90th $269–$1,0960%10%10th90th$417$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $5,754.40 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $446.68 / $1,122.02
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $281.84 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $7,762.47 / $16,595.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $275.42 / $575.44
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $1,995.26 / $8,912.51
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,862.09 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $446.68 / $1,047.13
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $407.38 / $1,000.00
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $389.05 / $588.84
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $346.74 / $616.60
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $6,165.95 / $9,549.93
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $398.11 / $776.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $3,981.07 / $9,772.37
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $457.09 / $3,090.30
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $1,174.90
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $776.25