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Other Throat, Tonsil or Adenoid Procedure

Kentucky rates for HCPCS 42999

Covers an operation on the throat, tonsils or adenoids that is unusual enough to have no standard name of its own. The surgeon writes a report describing exactly what was done and why, and that report is used to judge the work involved. What it covers depends entirely on the individual case.

Rates data updated October 2026.

How much does Other Throat, Tonsil or Adenoid Procedure cost?

$195

Typical negotiated rate. In Kentucky, October 2026.

Insurers have agreed to pay about $195 for this service. The price depends on where it is billed: about $195 from a physician practice, and about $513 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$195$151 to $204
FacilityA hospital or hospital-owned outpatient department$513$123 to $1,698

How much rates vary

Facilitymedian $513 · 10th to 90th $71 to $3,890Professionalmedian $195 · 10th to 90th $151 to $224
$50$200$1K$5Kfacility $513professional $195

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$851.14
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
None
Typical Low
$354.81
Median
$676.08
Typical High
$2,818.38
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$758.58
Median
$5,128.61
Typical High
$11,220.18
CareSource
Setting
Facility
Modifier
None
Typical Low
$316.23
Median
$1,698.24
Typical High
$2,818.38
CareSource
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$245.47
Typical High
$295.12
Cigna
Setting
Facility
Modifier
None
Typical Low
$34.67
Median
$467.74
Typical High
$794.33
Molina
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$186.21
Typical High
$204.17
United
Setting
Facility
Modifier
None
Typical Low
$70.79
Median
$186.21
Typical High
$1,148.15

Where Kentucky sits

The same service costs 102.3 times more in Pennsylvania 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.

Kentucky· 45th of 51

$195

PA $3,020HI $29.51

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.