Tonsil and Adenoid Removal (Child Under 12)
Mount Sinai West
What goes into a price?
Prices across providers
Self pay or cash prices vary by provider when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts providers charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the Tonsil and Adenoid Removal (Child Under 12) Standard Service Package (SSP EN000). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS 42820 | Base Code | Tonsil and Adenoid Removal (Child Under 12) |
| HCPCS 42820 | Professional Fee | Tonsil and Adenoid Removal (Child Under 12) |
| RC 0710 | Facility Fee | Recovery Room - General |
| RC 0360 | Facility Fee | Operating Room Services - General |
| RC 0370 | Facility Fee | Anesthesia - General |
| HCPCS J1100 | Facility Fee | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| RC 0250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| HCPCS J2405 | Facility Fee | Intramuscular injection of ondansetron hydrochloride, 1mg |
| RC 0636 | Facility Fee | Pharmacy - Extension of 025X - Drugs requiring detailed coding |
| HCPCS J2704 | Facility Fee | Intramuscular injection of 10mg propofol |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS 00170 | Professional Fee | Intraoral Anesthesia for Biopsy, Unspecified |
| RC 0272 | Facility Fee | Medical/Surgical Supplies and Devices (Also see 062X, an extension of 027X) - Sterile |