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Ohio rates for HCPCS 42825

Tonsillectomy, primary or secondary; younger than age 12

Facilitymedian $5,248 · 10th–90th $501$11,7490%10%10th90th$5,248Professionalmedian $316 · 10th–90th $240$8130%20%10th90th$316$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
$446.68 / $6,760.83 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $346.74 / $1,148.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $3,981.07 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $275.42 / $436.52
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $288.40 / $3,630.78
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $457.09 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $346.74 / $602.56
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $1,288.25 / $5,888.44
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $346.74 / $549.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $165.96
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
$245.47 / $288.40 / $549.54
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
$204.17 / $288.40 / $467.74