Tonsil and adenoid removal for patients under 12

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Tonsillectomy & Adenoidectomy <Age 12

Payers reporting CPT 42820

66 payers file a negotiated rate for this code. Each is shown once, under the terms the most hospitals file it under; rates under different terms (billing class, payment method, setting) are never blended, so open a payer to see them all. Figures are hospital-level averages; the median is across hospitals.

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1	UnitedHealthcare fee schedule · outpatient · +30 other terms	562	$5,563	$5,339	$49.60 – $173,841
2	Aetna fee schedule · outpatient · +29 other terms	500	$5,945	$6,220	$19.59 – $40,469
3	Humana fee schedule · outpatient · +24 other terms	391	$5,741	$4,667	$1.00 – $19,909
4	Blue Cross Blue Shield fee schedule · outpatient · +30 other terms	382	$7,250	$9,164	$1.00 – $42,938
5	Cigna case rate · outpatient · +24 other terms	348	$6,193	$7,108	$82.00 – $40,673
6	Molina fee schedule · outpatient · +24 other terms	233	$3,972	$3,584	$1.00 – $13,710
7	WellCare fee schedule · outpatient · +15 other terms	194	$6,094	$6,122	$254.19 – $13,864
8	Oscar case rate · outpatient · +17 other terms	136	$5,632	$5,538	$2,399 – $10,148
9	Anthem fee schedule · outpatient · +22 other terms	130	$3,945	$4,324	$193.53 – $43,319
10	Kaiser fee schedule · outpatient · +20 other terms	100	$7,516	$8,467	$36.00 – $41,997
11	Ambetter fee schedule · outpatient · +13 other terms	90	$9,179	$7,185	$70.50 – $14,287
12	Aetna Better Health fee schedule · outpatient · +11 other terms	78	$2,467	$2,606	$262.91 – $20,795
13	Devoted fee schedule · outpatient · +9 other terms	77	$6,040	$5,331	$268.17 – $6,683
14	Healthcare Highways case rate · outpatient · +2 other terms	76	$3,723	$4,177	$2,036 – $5,524
15	Caresource fee schedule · outpatient · +12 other terms	58	$4,190	$4,141	$272.50 – $10,116
16	Highmark facility · fee schedule · outpatient · +13 other terms	50	$5,967	$5,550	$4.50 – $20,928
17	Optum fee schedule · outpatient · +19 other terms	43	$5,371	$6,021	$286.36 – $21,852
18	Tricare fee schedule · outpatient · +15 other terms	42	$5,578	$4,738	$254.59 – $7,577
19	MultiPlan fee schedule · outpatient · +20 other terms	38	$7,701	$8,653	$254.00 – $10,219
20	Superior Healthplan case rate · outpatient · +4 other terms	38	$948.00	$1,190	$929.00 – $8,888
21	Amerihealth Caritas case rate · outpatient · +10 other terms	35	$566.83	$4,620	$535.50 – $10,472
22	Bcbs Tx fee schedule · outpatient · +2 other terms	33	$7,181	$7,001	$1,954 – $20,130
23	Clover fee schedule · outpatient · +8 other terms	33	$6,465	$6,275	$5,343 – $6,967
24	Regence professional · fee schedule · outpatient · +14 other terms	33	$230.24	$388.53	$117.68 – $919.36
25	Cigna Healthspring fee schedule · outpatient · +7 other terms	31	$5,827	$4,200	$2,052 – $6,313

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