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Ohio rates for HCPCS 42820

Tonsillectomy and adenoidectomy; younger than age 12

Facilitymedian $5,754 · 10th–90th $550–$10,7150%10%20%10th90th$5,754Professionalmedian $407 · 10th–90th $275–$1,0960%20%10th90th$407$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$549.54 / $6,165.95 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $467.74 / $1,380.38
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $309.03 / $346.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $3,548.13 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $309.03 / $501.19
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $354.81 / $501.19
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $346.74 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $562.34 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $380.19 / $660.69
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $3,548.13 / $8,511.38
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $380.19 / $602.56
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $181.97
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $7,244.36
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $316.23 / $588.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,570.88 / $8,709.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $316.23 / $512.86