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Tonsil Removal, Age 12 and Over

Washington 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.

Facilitymedian $7,586 · 10th–90th $363$15,1360%10%10th90th$7,586$200.0$500.0$1.0K$2.0K$5.0K$10.0K$20.0K

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
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$9,332.54
Typical High
$16,595.87
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$5,495.41
Median
$8,511.38
Typical High
$17,378.01
Cigna
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$1,071.52
Typical High
$3,981.07
Cigna
Setting
Facility
Modifier
52 · Reduced service
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$524.81
Typical High
$3,467.37
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$478.63
Typical High
$524.81
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$354.81
Typical High
$1,862.09
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$5,888.44
Median
$8,912.51
Typical High
$17,378.01
United
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$9,549.93
Typical High
$18,620.87