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Tonsil and Adenoid Removal, Age 12 and Over

Virginia rates for HCPCS 42821

Removal of both the tonsils at the back of the throat and the adenoid tissue higher up behind the nose, in a patient aged twelve or older. It is done through the open mouth under general anesthesia with no cuts on the outside, for repeated infections or for breathing that is blocked during sleep. Recovery tends to be more uncomfortable in older patients than in young children.

Rates data updated July 2026.

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

$813

Typical facility fee. In Virginia, July 2026.

Insurers have agreed to pay about $813 for this service. Most negotiated rates run $380 to $6,166.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $1,122 · 10th to 90th $339 to $10,965Professionalmedian $372 · 10th to 90th $269 to $646
$200$500$1K$2K$5K$10Kfacility $1,122professional $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
$416.87
Median
$5,370.32
Typical High
$11,481.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$3,981.07
Typical High
$4,466.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$1,412.54
Typical High
$1,584.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$316.23
Typical High
$645.65
Medcost
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$467.74
Typical High
$660.69
Medcost
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$407.38
Typical High
$616.60
Sentara
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$380.19
Typical High
$1,445.44
United
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$5,754.40
Typical High
$13,182.57

Where Virginia sits

The same service costs 23.4 times more in Connecticut than in Maryland. 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.

Virginia· 43rd of 50

$813

CT $8,318MD $355

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.