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Other Throat, Tonsil or Adenoid Procedure

New Jersey 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 July 2026.

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

$5,495

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $5,495 for this service. The price depends on where it is billed: about $5,370 from a physician practice, and about $5,888 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$5,370$4,266 to $6,166
FacilityA hospital or hospital-owned outpatient department$5,888$3,981 to $7,079

How much rates vary

Facilitymedian $5,888 · 10th to 90th $2,291 to $10,715Professionalmedian $5,370 · 10th to 90th $2,291 to $11,749
$500$1K$2K$5K$10Kfacility $5,888professional $5,370

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
$3,311.31
Median
$6,025.60
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3,162.28
Median
$5,370.32
Typical High
$11,748.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$707.95
Typical High
$1,071.52
United
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$2,691.53
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57

Where New Jersey sits

The same service costs 34.7 times more in Wisconsin than in Maine. 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.

New Jersey· 2nd of 50

$5,495

WI $11,482ME $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.