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Repeat Adenoid Removal, Age 12+

Washington, DC rates for HCPCS 42836

This procedure removes adenoid tissue, glands located behind the nose above the throat, that has regrown or was left behind after an earlier removal. It is performed in a patient who is at least 12 years old. It is typically done when the adenoid tissue causes ongoing nasal blockage, breathing problems during sleep, or repeated ear or sinus infections despite a prior removal.

Rates data updated July 2026.

How much does Repeat Adenoid Removal, Age 12+ cost?

$282

Typical physician fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $282 for this service. Most negotiated rates run $251 to $355.

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 $4,074 · 10th to 90th $661 to $7,762Professionalmedian $269 · 10th to 90th $219 to $355
$200$500$1K$2K$5K$10K$20Kfacility $4,074professional $269

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
$295.12
Median
$3,388.44
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$269.15
Typical High
$295.12
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$263.03
Typical High
$4,466.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$323.59
Typical High
$691.83
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$251.19
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$10,000.00
Typical High
$26,302.68
United
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$288.40
Typical High
$602.56

Where Washington, DC sits

The same service costs 2.2 times more in Minnesota than in Delaware. 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.

Washington, DC· 40th of 51

$282

MN $575DE $257

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.