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Pennsylvania rates for HCPCS 42821

Tonsillectomy and adenoidectomy; age 12 or over

Facilitymedian $6,457 · 10th–90th $1,047–$11,7490%5%10%10th90th$6,457$500.0$1.0K$2.0K$5.0K$10.0K$20.0K$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
$1,148.15 / $6,606.93 / $11,748.98
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $6,025.60 / $28,840.32
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $6,606.93 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $1,995.26 / $3,715.35
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,344.23 / $2,630.27
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $8,511.38 / $14,454.40
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $5,128.61 / $8,317.64
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $4,570.88 / $9,549.93
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $407.38 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $3,311.31 / $10,715.19