Cost of a Tonsillectomy Visit
in Colorado
Reviewed by Momentary Medical Group West PC
Colorado's healthcare market runs approximately 7% above national averages, with competitive ambulatory surgery center networks centered in Denver driving significant price variation for tonsillectomy procedures. Patients typically pay between $85 and $694 for tonsillectomy visits, with a median cost of $385. The state maintains over 1,400 active tonsillectomy providers across urban centers like Denver-Boulder and rural mountain communities, giving patients multiple options to browse providers throughout Colorado.
Average
$388
Median
$385
Lowest
$85
Highest
$694
Providers
1,441
8% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Colorado?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,136 | $2,049 | $3,475 | 1,282 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $940 | $1,978 | $3,328 | 1,345 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $808 | $2,114 | 1,468 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $452 | $805 | $1,326 | 1,321 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $90 | $940 | $1,635 | 1,256 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $85 | $789 | $1,421 | 1,461 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,202 | $2,204 | 1,315 |
| Septoplasty Nasal septum repair | 30520 | $526 | $855 | $1,567 | 1,308 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $441 | $712 | $1,242 | 1,269 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $877 | $1,561 | 1,292 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $364 | $629 | $1,110 | 1,293 |
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 Colorado
These hospitals in Colorado are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
DURANGO, CO
FRISCO, CO
LAKEWOOD, CO
GRAND JUNCTION, CO
CORTEZ, CO
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 Colorado
Colorado's healthcare costs run approximately 7% above national averages, driven by the state's challenging geography that creates significant access disparities between Front Range urban centers and remote mountain communities. The competitive Denver metro market contrasts sharply with limited provider options in rural areas, creating substantial cost variation for specialized procedures like tonsillectomy.
Urban vs. Rural Provider Availability
The Denver-Boulder-Fort Collins corridor contains the majority of Colorado's ENT specialists, while vast rural areas including the Western Slope and Eastern Plains rely on periodic visiting specialists or patient travel for tonsillectomy procedures. Mountain communities like Vail and Aspen maintain some specialty services but at premium pricing reflecting local cost structures. Rural patients often face 2-3 hour drives to access pediatric ENT specialists, making procedure scheduling more complex and costly.
Facility Type and Overhead Costs
Major health systems like UCHealth, Presbyterian/St. Joseph, and SCL Health operate hospital-based ENT departments with higher overhead costs reflected in facility fees for tonsillectomy procedures. Independent ambulatory surgery centers, particularly concentrated in the Denver metro area, often provide more competitive pricing while maintaining accreditation standards. Specialty hospitals like National Jewish Health command premium rates for complex ENT cases but may not be cost-effective for routine tonsillectomy procedures.
Insurance Market Competition in Colorado
UnitedHealth, Anthem, and Kaiser Permanente compete actively in Colorado's individual and group markets, with Kaiser's integrated model often providing different cost structures for ENT services. The state's competitive marketplace helps moderate premium growth, though high-deductible health plans shift more tonsillectomy costs to patients as out-of-pocket expenses. Rural areas have fewer insurer options, potentially limiting network choices for ENT specialty care.
Physician Supply and Demand in Colorado
Colorado maintains over 1,400 active providers performing tonsillectomy procedures, indicating relatively good specialist availability compared to many states with ENT shortages. The concentration of providers in urban areas creates competitive pricing in metro markets while rural shortage areas command higher rates. Wait times for routine tonsillectomy procedures are generally reasonable in Front Range cities but may extend several weeks in underserved rural regions.
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 Colorado
What is the average cost of a Tonsillectomy visit in Colorado without insurance?
Does Colorado Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Colorado?
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 Colorado?
How does telemedicine affect the cost of seeing a Tonsillectomy in Colorado?
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 |