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First-Time Removal of the Adenoids

California rates for HCPCS 42831

Removes the adenoids, the pad of soft immune tissue at the back of the nose above the roof of the mouth, working through the open mouth with no cuts on the outside. It is the first operation on the adenoids, done when they block the nose, disturb sleep, or contribute to repeated ear and sinus trouble. Most patients go home the same day.

Rates data updated July 2026.

How much does First-Time Removal of the Adenoids cost?

$6,607

Typical facility fee. In California, July 2026.

Insurers have agreed to pay about $6,607 for this service. Most negotiated rates run $3,981 to $10,233.

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 9 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $7,244 · 10th to 90th $813 to $15,849Professionalmedian $257 · 10th to 90th $178 to $525
$100$500$2K$10Kfacility $7,244professional $257

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
$2,454.71
Median
$7,244.36
Typical High
$22,908.68
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,570.88
Median
$7,943.28
Typical High
$15,848.93
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$5,888.44
Typical High
$12,022.64
Cigna
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,584.89
Typical High
$2,818.38
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$177.83
Typical High
$346.74
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$257.04
Typical High
$537.03
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$8,317.64
Median
$8,317.64
Typical High
$33,884.42
Providence
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$302.00
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$2,884.03
Median
$7,079.46
Typical High
$15,135.61

Where California sits

The same service costs 24.5 times more in Connecticut than in Maryland. 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.

California· 5th of 51

$6,607

CT $7,079MD $288

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.