Tonsil and adenoid removal (under 12)

Surgical removal of the tonsils and adenoids in a child under 12.
Code 42820 · Surgery & procedures · statewide summary · negotiated in-network prices
Payers shown: Kaiser Permanente
Prices shown: surgery centers and hospital outpatient departments
Doctor’s fee or facility fee? This mixes two kinds of price: 83% are doctors' fees, 10% are facility fees paid to a hospital or surgery center and 7% cover both. Facility fees are usually far higher, so a wide spread can be the two kinds side by side, not providers charging wildly different amounts. Either way, expect a doctor's fee and a facility fee as separate bills when this is done in a hospital or surgery center. Where a state has both, the table and each state’s popup show the doctor’s fee and the facility fee side by side; their sum is a rough total for the visit, before anything else done during it.
Who is counted: Kaiser Permanente lists clinicians individually: 95% of the 862,255 provider IDs (NPIs) it names are individual doctors, nurse practitioners and therapists; the rest are practices, clinics and hospitals. “Providers” counts those IDs. Kaiser Permanente’s files name 388,241 providers for this procedure; 3,699 are counted here: the clinicians whose specialty performs it — mostly Otolaryngology, Clinic/Center and Clinical Medical Laboratory — 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.
StateProvidersNamed in filesOrganisationsZip codes Lowest25th pctMedian75th pctHighestDoctor’s feeFacility feevs 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.
This is a statewide summary. Prices vary far more between towns and between practices than these medians suggest; zip-code and provider-level detail is not published here; this specific data can be requested here.