# Tonsil and adenoid removal (under 12): what Anthem Blue Cross and Blue Shield pays, by state

Surgical removal of the tonsils and adenoids in a child under 12.

- Insurer: Anthem Blue Cross and Blue Shield
- Billing code: 42820 (Surgery & procedures)
- Price shown: negotiated in-network price, surgery center / hospital outpatient, doctor's and facility fees
- Prices as of: unknown
- All of the insurer's plans pooled; the map also shows single networks

| State | Providers | Named in files | Lowest | 25th pct | Median | 75th pct | Highest | Medicare pays | Median vs Medicare |
|---|---|---|---|---|---|---|---|---|---|
| Alabama | 2 | 306 | $1,275.00 | $1,472.65 | $1,774.83 | $2,091.05 | $2,768.50 | $239.32 | 7.4x Medicare |
| Arizona | 4 | 592 | $250.58 | $396.92 | $396.92 | $595.38 | $595.38 | $254.80 | 1.6x Medicare |
| Arkansas | 2 | 213 | $250.58 | $292.66 | $398.49 | $432.55 | $631.65 | $236.66 | 1.7x Medicare |
| California | 267 | 1,744 | $250.58 | $6,213.00 | $8,888.50 | $12,212.75 | $29,048.00 | $275.80 | 32x Medicare |
| Colorado | 187 | 811 | $282.04 | $5,953.50 | $10,277.00 | $13,811.00 | $28,029.00 | $264.84 | 39x Medicare |
| Connecticut | 30 | 395 | $527.00 | $6,380.00 | $8,384.00 | $12,103.00 | $16,699.00 | $275.74 | 30x Medicare |
| Florida | 10 | 2,637 | $282.04 | $396.92 | $443.38 | $595.38 | $866.88 | $279.86 | 1.6x Medicare |
| Georgia | 389 | 1,713 | $282.04 | $622.35 | $950.00 | $2,022.46 | $23,111.09 | $260.16 | 3.6x Medicare |
| Hawaii | 1 | 109 | $282.04 | $317.30 | $352.55 | $387.81 | $423.06 | $266.80 | 1.3x Medicare |
| Idaho | 1 | 104 | $396.92 | $446.54 | $496.15 | $545.77 | $595.38 | $242.17 | 2.0x Medicare |
| Illinois | 45 | 3,418 | $282.04 | $396.92 | $595.38 | $1,996.50 | $18,228.00 | $275.79 | 2.2x Medicare |
| Indiana | 1,873 | 42,262 | $243.28 | $396.92 | $429.33 | $595.38 | $36,540.00 | $243.15 | 1.8x Medicare |
| Iowa | 1 | 179 | $396.92 | $446.54 | $496.15 | $545.77 | $595.38 | $240.15 | 2.1x Medicare |
| Kansas | 2 | 254 | $294.81 | $468.19 | $631.65 | $1,766.68 | $3,709.00 | $241.11 | 2.6x Medicare |
| Kentucky | 1,882 | 25,816 | $243.28 | $357.93 | $421.10 | $442.21 | $14,571.00 | $247.66 | 1.7x Medicare |
| Louisiana | 1 | 212 | $396.92 | $446.54 | $496.15 | $545.77 | $595.38 | $252.75 | 2.0x Medicare |
| Maine | 18 | 1,069 | $444.55 | $577.92 | $666.82 | $866.88 | $1,481.46 | $248.88 | 2.7x Medicare |
| Maryland | 6 | 437 | $282.04 | $396.92 | $444.55 | $591.02 | $866.88 | $268.59 | 1.7x Medicare |
| Massachusetts | 73 | 4,825 | $282.04 | $466.77 | $606.81 | $716.84 | $1,083.60 | $274.52 | 2.2x Medicare |
| Michigan | 16 | 2,211 | $282.04 | $282.04 | $423.06 | $423.06 | $6,737.00 | $262.56 | 1.6x Medicare |
| Minnesota | 4 | 614 | $282.04 | $310.76 | $409.99 | $423.06 | $595.38 | $250.00 | 1.6x Medicare |
| Mississippi | 1 | 163 | $396.92 | $396.92 | $496.15 | $595.38 | $595.38 | $241.28 | 2.1x Medicare |
| Missouri | 246 | 1,762 | $203.77 | $570.91 | $856.36 | $2,087.00 | $13,135.00 | $252.00 | 3.4x Medicare |
| Nebraska | 1 | 126 | $396.92 | $446.54 | $496.15 | $545.77 | $595.38 | $240.61 | 2.1x Medicare |
| Nevada | 47 | 261 | $337.38 | $5,681.00 | $5,744.88 | $5,808.75 | $8,424.00 | $257.67 | 22x Medicare |
| New Hampshire | 264 | 10,775 | $282.04 | $577.92 | $866.88 | $1,202.97 | $9,236.00 | $262.66 | 3.3x Medicare |
| New Jersey | 5 | 464 | $282.04 | $444.55 | $586.65 | $866.88 | $12,465.00 | $282.65 | 2.1x Medicare |
| New York | 286 | 1,496 | $282.04 | $2,980.25 | $7,596.50 | $10,774.00 | $24,343.00 | $286.46 | 27x Medicare |
| North Carolina | 3 | 987 | $282.04 | $396.92 | $409.99 | $552.30 | $595.38 | $246.79 | 1.7x Medicare |
| Ohio | 2,659 | 35,437 | $243.28 | $282.04 | $423.06 | $423.06 | $22,458.00 | $251.98 | 1.7x Medicare |
| Oregon | 1 | 252 | $444.55 | $544.58 | $622.37 | $716.84 | $866.88 | $262.07 | 2.4x Medicare |
| Pennsylvania | 21 | 1,562 | $282.04 | $286.22 | $423.06 | $631.51 | $8,179.00 | $261.33 | 1.6x Medicare |
| South Carolina | 1 | 513 | $295.52 | $332.46 | $369.40 | $406.34 | $443.28 | $250.01 | 1.5x Medicare |
| Tennessee | 16 | 1,879 | $243.28 | $347.66 | $421.10 | $521.49 | $2,475.00 | $242.28 | 1.7x Medicare |
| Texas | 21 | 1,846 | $243.28 | $352.79 | $423.06 | $577.92 | $5,933.00 | $258.60 | 1.6x Medicare |
| Utah | 2 | 190 | $312.40 | $444.55 | $577.92 | $666.82 | $866.88 | $252.62 | 2.3x Medicare |
| Vermont | 30 | 807 | $444.55 | $577.92 | $666.82 | $866.88 | $2,740.43 | $250.09 | 2.7x Medicare |
| Virginia | 19 | 743 | $243.28 | $375.88 | $442.21 | $7,175.00 | $12,814.00 | $253.30 | 1.8x Medicare |
| Washington | 2 | 427 | $282.04 | $282.04 | $352.55 | $423.06 | $423.06 | $275.57 | 1.3x Medicare |
| West Virginia | 41 | 1,322 | $243.28 | $294.81 | $421.10 | $442.21 | $631.65 | $255.75 | 1.6x Medicare |
| Wisconsin | 98 | 623 | $282.04 | $7,483.00 | $10,283.00 | $13,955.00 | $24,069.00 | $242.86 | 42x Medicare |

**“x Medicare”** compares each price with what original Medicare pays a doctor for the same service in the same state under its physician fee schedule (RVU26D, in force from 2026-10-01) — the lower price a doctor is paid when a hospital or surgery center provides the room and equipment. Insurers write their contracts as a share of Medicare, so 1.3x means the insurer pays 30% more than Medicare would; Medicare Advantage plans generally pay close to 1.0x. The prices on this map include a **facility fee**, which Medicare pays separately and which is not in its physician price, so the ratio here runs high and is a rough guide only.

Anthem Blue Cross and Blue Shield’s files name **151,556 providers** for this procedure; **8,578** are counted here: the clinicians whose specialty performs it and the practices, clinics and hospitals. Insurers attach their whole fee schedule to every contracted provider, so the rest are clinicians listed at a price for something they never do; counting them would inflate the provider count and pull the typical price towards the fee schedule’s floor.

Prices are what the insurer has agreed to pay, not what you will be billed. This is a statewide summary: prices vary far more between towns and between practices than these medians suggest, and "providers" counts everyone with a contracted price, not only those who perform the procedure.

Map: https://medicalpricetransparency.netlify.app/insurers/anthem/statemap_42820_US.html  
About this insurer's data, and its other procedures: [index.md](index.md)