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Tonsil Removal, Age 12 and Over

South Carolina rates for HCPCS 42826

Surgical removal of the tonsils, the two pads of tissue at the back of the throat, 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 throat infections, ongoing tonsil trouble or blocked breathing during sleep. The adenoids are left in place.

Rates data updated July 2026.

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

$5,248

Typical facility fee. In South Carolina, July 2026.

Insurers have agreed to pay about $5,248 for this service. Most negotiated rates run $437 to $9,550.

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.

How much rates vary

Facilitymedian $5,370 · 10th to 90th $302 to $12,589Professionalmedian $380 · 10th to 90th $355 to $407
$500$1K$2K$5K$10K$20Kfacility $5,370professional $380

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$6,760.83
Typical High
$12,589.25
Aetna
Setting
Facility
Modifier
52 · Reduced service
Typical Low
$151.36
Median
$151.36
Typical High
$338.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$4,073.80
Typical High
$9,549.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$707.95
Typical High
$1,778.28
Medcost
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$380.19
Typical High
$407.38
Medcost
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$354.81
Typical High
$562.34
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$10,232.93
Typical High
$16,595.87

Where South Carolina sits

The same service costs 24.5 times more in Indiana than in Hawaii. 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.

South Carolina· 14th of 51

$5,248

IN $8,128HI $331

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.