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Tonsil Removal Surgery For A Child

New Jersey rates for HCPCS 42825

This procedure surgically removes the tonsils, the soft tissue masses at the back of the throat, in a child younger than a certain early adolescent age. It is done through the mouth without external incisions and is commonly performed for recurring throat infections or airway obstruction during sleep.

Rates data updated July 2026.

How much does Tonsil Removal Surgery For A Child cost?

$316

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $316 for this service. The price depends on where it is billed: about $295 from a physician practice, and about $6,918 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 5 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$295$251 to $427
FacilityA hospital or hospital-owned outpatient department$6,918$5,495 to $9,550

How much rates vary

Facilitymedian $6,918 · 10th to 90th $3,890 to $11,749Professionalmedian $295 · 10th to 90th $229 to $851
$200$500$1K$2K$5K$10K$20Kfacility $6,918professional $295

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
$4,466.84
Median
$7,079.46
Typical High
$11,748.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$281.84
Typical High
$5,888.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$346.74
Typical High
$707.95
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$346.74
Typical High
$501.19
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$12,022.64
Median
$21,379.62
Typical High
$30,902.95
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$302.00
Typical High
$645.65
United
Setting
Facility
Modifier
Global
Typical Low
$2,511.89
Median
$5,888.44
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$302.00
Typical High
$562.34

Where New Jersey sits

The same service costs 3.5 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.

New Jersey· 41st of 51

$316

WY $977DE $282

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.