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New York rates for HCPCS 42825

Tonsillectomy, primary or secondary; younger than age 12

Facilitymedian $5,888 · 10th–90th $427$11,7490%5%10th90th$5,888Professionalmedian $355 · 10th–90th $240$9550%10%10th90th$355$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
$354.81 / $5,623.41 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $338.84 / $954.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $7,762.47 / $13,803.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $245.47 / $524.81
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $2,398.83 / $10,964.78
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $2,290.87 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $407.38 / $954.99
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $371.54 / $933.25
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $371.54 / $549.54
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $316.23 / $575.44
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $7,762.47 / $9,549.93
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $398.11 / $707.95
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
$257.04 / $426.58 / $2,691.53
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $323.59 / $1,071.52
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $323.59 / $691.83