Cost of a Tonsillectomy Visit
in California
Reviewed by Momentary Medical Group West PC
California's healthcare market operates 18% above national averages, making cost transparency critical for patients considering tonsillectomy procedures. With over 1,700 active providers across the state performing tonsillectomy procedures (CPT 42820), patients typically pay between $80 and $705, with a median cost of $265 based on negotiated insurance rates. California residents can browse all qualified tonsillectomy providers to compare costs and find the most affordable option in their area.
Average
$350
Median
$265
Lowest
$80
Highest
$705
Providers
1,717
17% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in California?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Endometrial Ablation Cost of endometrial ablation procedures including NovaSure (hysteroscopic), thermal balloon, and cryoablation, with state-by-state pricing. | 58563 | $245 | $1,904 | $6,978 | 778 |
| Chin Liposuction Cost of chin (submental) liposuction across the US, with state-by-state pricing for both office-based and ambulatory surgery center settings. | 15876 | $304 | $510 | $972 | 39 |
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $75 | $2,228 | $3,286 | 3,142 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $80 | $2,021 | $3,012 | 3,930 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $1,210 | $1,401 | 2,015 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $80 | $80 | $8,767 | 4,867 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $75 | $1,094 | $1,714 | 6,358 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $933 | $1,375 | 7,138 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,135 | $2,758 | 1,473 |
| Septoplasty Nasal septum repair | 30520 | $80 | $820 | $2,160 | 897 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $423 | $975 | $1,216 | 2,424 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $961 | $1,972 | 1,786 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $80 | $261 | $1,930 | 2,261 |
Important: These are cost estimates only — not a quote and not medical advice.
The prices on this page are self-pay rates, drawn from federal Transparency in Coverage machine-readable files (CPT 42820 — Tonsillectomy and adenoidectomy). They represent what a patient might pay without insurance.
Your actual cost depends on: your specific insurance plan, your remaining deductible, your coinsurance percentage, whether you have met your out-of-pocket maximum, whether the facility and provider are both in-network, and any separate anesthesia or implant fees billed independently.
This page does not constitute medical advice. Whether you need this procedure, and which approach is right for you, is a decision to make with a licensed healthcare provider.
Where this data comes from & what CPT 42820 covers
Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 42820 (Tonsillectomy and adenoidectomy), as mandated by the CMS Price Transparency Rule.
What CPT 42820 covers: the provider's professional fee for tonsillectomy. It does not include facility/hospital fees, anesthesia, pre-operative imaging, post-operative care, or any add-on codes billed separately.
How to read this data
Negotiated Rate
The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number, not the higher list price hospitals publish separately.
P5, Median, P95
P5 is the rate at the 5th percentile (low end), Median is the middle value, and P95 is the 95th percentile (high end). This range shows how much the same visit can vary between providers.
What this does not tell you
These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Call your insurer's member line to get your exact estimate.
Top-Rated Hospitals in California
These hospitals in California are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
SANTA CRUZ, CA
IRVINE, CA
FRESNO, CA
MAMMOTH LAKES, CA
TRUCKEE, CA
Hospital ratings are based on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey data published by CMS.
Why Tonsillectomy Visit Costs Vary Across California
California's healthcare costs run approximately 18% above national averages, driven by the state's high cost of living, strict regulatory environment, and concentrated metropolitan markets. The state's geographic diversity creates stark cost variations between urban coastal regions and rural inland areas.
Urban vs. Rural Provider Availability
Major metropolitan areas like San Francisco, Los Angeles, and San Diego maintain high concentrations of ENT specialists, while rural counties in the Central Valley and Northern California often face provider shortages. This geographic disparity forces rural patients to travel to urban centers, potentially increasing overall treatment costs but sometimes accessing lower-priced providers outside premium markets. Telemedicine consultations have helped bridge some access gaps, though surgical procedures still require in-person care.
Facility Type and Overhead Costs
California's dominant health systems including Kaiser Permanente, Sutter Health, and Cedars-Sinai operate extensive networks of hospital-based outpatient facilities with higher overhead costs than independent surgery centers. Academic medical centers like UCLA and UCSF often charge premium rates due to their teaching hospital status and specialized equipment. Independent ambulatory surgery centers frequently offer more competitive pricing for routine tonsillectomy procedures.
Insurance Market Competition in California
The state's insurance market features robust competition between Anthem Blue Cross, Kaiser Permanente, and UnitedHealthcare, each maintaining different negotiated rates with providers. Kaiser's integrated delivery model often results in more predictable costs but limits provider choice compared to traditional PPO plans. Regional insurers and Medicaid managed care organizations add additional competitive pressure, particularly in areas with high Medi-Cal enrollment.
Physician Supply and Demand in California
With over 1,700 providers performing tonsillectomy procedures statewide, California maintains adequate ENT specialist availability in most regions, though distribution remains uneven. The large provider supply in metropolitan areas creates competitive pricing pressure, while rural shortages can drive up costs due to limited options. Lengthy wait times in high-demand areas may push some patients toward higher-priced providers with immediate availability.
Jayant Panwar
CEO, Momentary Labs · San Francisco, CA
Jayant has analyzed healthcare pricing data from CMS Transparency in Coverage files since 2022, covering more than 50 million negotiated rate records across all 50 states. His work focuses on making insurer machine-readable files accessible to patients and researchers.
The cost figures on this page reflect his ongoing work to make this data accessible to patients.
Frequently Asked Questions — Tonsillectomy Costs in California
What is the average cost of a Tonsillectomy visit in California without insurance?
Does California Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in California?
What is the difference in cost between an initial consultation and a follow-up visit?
Can I use an HSA or FSA to pay for a Tonsillectomy visit in California?
How does telemedicine affect the cost of seeing a Tonsillectomy in California?
Click a state to compare costs
Average Visit Cost
Office visit (CPT 42820)
Compare With Other States
| Rank | State | Average↓ |
|---|---|---|
| 1 | Wisconsin Range: $95 – $1,404 | $682 |
| 2 | Massachusetts Range: $219 – $1,237 | $637 |
| 3 | Wyoming Range: $351 – $894 | $575 |
| 4 | Nebraska Range: $347 – $705 | $564 |
| 5 | New Hampshire Range: $290 – $831 | $556 |
| 6 | Georgia Range: $196 – $981 | $552 |
| 7 | Washington Range: $324 – $889 | $549 |
| 8 | Maine Range: $342 – $578 | $498 |
| 9 | North Dakota Range: $237 – $820 | $485 |
| 10 | Iowa Range: $95 – $705 | $480 |
| 11 | North Carolina Range: $217 – $820 | $478 |
| 12 | Rhode Island Range: $239 – $742 | $474 |
| 13 | District of Columbia Range: $220 – $681 | $460 |
| 14 | New Mexico Range: $253 – $694 | $459 |
| 15 | South Dakota Range: $197 – $705 | $438 |
| 16 | Missouri Range: $268 – $559 | $436 |
| 17 | Connecticut Range: $194 – $742 | $432 |
| 18 | New Jersey Range: $170 – $833 | $425 |
| 19 | Oregon Range: $85 – $774 | $424 |
| 20 | Vermont Range: $220 – $693 | $418 |
| 21 | Minnesota Range: $94 – $705 | $415 |
| 22 | Mississippi Range: $230 – $725 | $412 |
| 23 | Utah Range: $85 – $643 | $408 |
| 24 | Alaska Range: $85 – $768 | $408 |
| 25 | New York Range: $203 – $742 | $407 |
| 26 | Pennsylvania Range: $149 – $742 | $402 |
| 27 | Michigan Range: $238 – $559 | $402 |
| 28 | Illinois Range: $253 – $596 | $396 |
| 29 | West Virginia Range: $85 – $748 | $396 |
| 30 | Delaware Range: $154 – $698 | $390 |
| 31 | Colorado Range: $85 – $694 | $388 |
| 32 | Alabama Range: $195 – $615 | $387 |
| 33 | Tennessee Range: $234 – $559 | $386 |
| 34 | Idaho Range: $85 – $679 | $384 |
| 35 | Hawaii Range: $85 – $665 | $383 |
| 36 | South Carolina Range: $194 – $644 | $381 |
| 37 | Kentucky Range: $85 – $679 | $374 |
| 38 | Maryland Range: $226 – $607 | $368 |
| 39 | Virginia Range: $192 – $589 | $362 |
| 40 | Indiana Range: $85 – $649 | $360 |
| 41 | Kansas Range: $268 – $463 | $359 |
| 42 | Louisiana Range: $189 – $530 | $355 |
| 43 | Oklahoma Range: $232 – $540 | $354 |
| 44 | California Range: $80 – $705 | $350 |
| 45 | Arkansas Range: $85 – $561 | $348 |
| 46 | Texas Range: $85 – $597 | $332 |
| 47 | Nevada Range: $228 – $481 | $331 |
| 48 | Montana Range: $85 – $581 | $326 |
| 49 | Arizona Range: $240 – $480 | $320 |
| 50 | Ohio Range: $85 – $559 | $313 |
| 51 | Florida Range: $35 – $505 | $198 |