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

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

- Insurer: Independence Blue Cross
- Billing code: 42820 (Surgery & procedures)
- Price shown: negotiated in-network price, surgery center / hospital outpatient, doctor's and facility fees
- Prices as of: 2026-08-31
- All of the insurer's plans pooled; the map also shows single networks

| State | Providers | Lowest | 25th pct | Median | 75th pct | Highest | Medicare pays | Median vs Medicare |
|---|---|---|---|---|---|---|---|---|
| New Jersey | 2 | $236.30 | $354.45 | $472.59 | $1,380.00 | $2,287.41 | $282.65 | 1.7x Medicare |
| Pennsylvania | 15 | $197.78 | $5,438.28 | $6,351.56 | $7,728.11 | $9,302.40 | $261.33 | 24x 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.

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/independence/statemap_42820_US.html  
About this insurer's data, and its other procedures: [index.md](index.md)