Logo
Georgia

Cost of a Tonsillectomy Visit
in Georgia

Reviewed by Momentary Medical Group West PC

Georgia's healthcare market operates roughly 1% below national cost averages, with over 3,000 active Tonsillectomy providers serving patients across the state's diverse urban and rural communities. Tonsillectomy visit costs typically range from $196 to $981, with a median rate of $479 based on negotiated insurance rates. You can browse all qualified Tonsillectomy specialists throughout Georgia to find the right provider for your needs.

Average

$552

Median

$479

Lowest

$196

Highest

$981

Providers

3,030

National avg: $420Georgia: $552

31% above national average

Compare Similar Procedures

How does tonsillectomy compare to related procedures in Georgia?

ProcedureCPTLowMedianHighProviders
Knee Replacement

Total knee replacement (arthroplasty)

27447$1,131$2,136$5,0822,851
Hip Replacement

Total hip replacement (arthroplasty)

27130$1,115$2,021$5,0882,920
Cataract Surgery

Cataract extraction with intraocular lens insertion

66984$93$811$2,0053,287
Knee Arthroscopy

Arthroscopy of the knee with meniscectomy

29881$450$854$2,0242,855
Gallbladder Removal (Laparoscopic)

Laparoscopic cholecystectomy

47562$553$1,141$2,4902,917
Appendectomy (Laparoscopic)

Laparoscopic appendectomy

44970$85$976$2,0383,158
Hysterectomy (Laparoscopic)

Laparoscopic total hysterectomy

58571$85$1,337$2,8553,043
Septoplasty

Nasal septum repair

30520$499$950$2,1902,853
Inguinal Hernia Repair

Inguinal hernia repair

49505$421$902$1,9692,843
Mastectomy

Partial or simple mastectomy

19301$350$982$2,4733,025
Carpal Tunnel Surgery

Open carpal tunnel release

64721$344$646$1,9302,848

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 42820Tonsillectomy 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 Georgia

These hospitals in Georgia are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.

5/5
94% would recommend180 patient surveys
5/5
89% would recommend103 patient surveys
5/5
85% would recommend163 patient surveys
ADVENTHEALTH MURRAY

CHATSWORTH, GA

5/5
80% would recommend122 patient surveys
5/5
80% would recommend491 patient surveys

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 Georgia

Georgia's healthcare costs run approximately 1% below the national average, driven by lower facility overhead outside Atlanta and competitive pressure from the state's large provider networks. The state's mix of major metropolitan areas and extensive rural counties creates significant cost variations for specialist care like Tonsillectomy services.

Urban vs. Rural Provider Availability

Atlanta's metro area concentrates most of Georgia's ENT specialists, while rural counties in south and central Georgia face significant provider shortages. Patients in Columbus, Augusta, and Savannah have reasonable access to Tonsillectomy care, but those in smaller towns may need to travel considerable distances or face longer wait times.

Facility Type and Overhead Costs

Hospital-owned practices dominate Georgia's major markets, with systems like Emory Healthcare, Piedmont, and Augusta University Health controlling significant market share. These hospital-affiliated clinics typically charge higher facility fees compared to independent ENT practices, which remain more common in smaller cities and suburban areas.

Insurance Market Competition in Georgia

Anthem Blue Cross Blue Shield holds the largest market share in Georgia, followed by UnitedHealthcare and Cigna, creating moderate competition that helps keep negotiated rates reasonable. The state's decision to use the federal marketplace rather than create its own exchange has limited some insurer participation, potentially reducing competitive pressure in certain regions.

Physician Supply and Demand in Georgia

With over 3,000 active Tonsillectomy providers statewide, Georgia has adequate specialist supply in urban areas but significant shortages in rural counties. This supply-demand imbalance keeps wait times and prices higher in underserved areas while creating competitive pricing in Atlanta and other metropolitan markets.

JP

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.

Healthcare Data AnalyticsCMS TiC DataInsurance Price Transparency

Frequently Asked Questions — Tonsillectomy Costs in Georgia

What is the average cost of a Tonsillectomy visit in Georgia without insurance?

Self-pay patients in Georgia typically pay between $196 and $981 for a Tonsillectomy consultation, with a median cost of $479. Many providers offer cash-pay discounts of 20-40% for upfront payment, and payment plans are commonly available to make care more affordable.

Does Georgia Medicaid cover Tonsillectomy visits?

Yes, Georgia Medicaid covers medically necessary Tonsillectomy visits, but eligibility is limited since the state chose not to expand Medicaid. Coverage includes consultations, diagnostic tests, and surgical procedures when deemed medically appropriate, though prior authorization may be required for some services.

How do I find an affordable Tonsillectomy near me in Georgia?

Compare costs across different facility types, as independent practices often charge less than hospital-owned clinics. Ask about self-pay discounts, consider community health centers if you're uninsured, and look at providers in smaller cities where overhead costs may be lower than in Atlanta.

What is the difference in cost between an initial consultation and a follow-up visit?

Initial Tonsillectomy consultations typically cost $196-$981 with a median of $479, while follow-up visits generally run significantly less since they require less time and documentation. The exact difference depends on your insurance plan's copay structure and the complexity of your case.

Can I use an HSA or FSA to pay for a Tonsillectomy visit in Georgia?

Yes, Tonsillectomy consultations qualify as eligible medical expenses for both HSA and FSA accounts. You can use these pre-tax dollars for copays, deductibles, and any out-of-pocket costs related to your ENT care, including diagnostic tests ordered during your visit.

How does telemedicine affect the cost of seeing a Tonsillectomy in Georgia?

Telemedicine visits for ENT care typically cost 20-50% less than in-person consultations in Georgia, though physical examination limitations make them most suitable for follow-up visits or initial symptom discussion. Many insurers now cover telehealth ENT visits at the same rate as office visits, making them an affordable option for routine care.

Click a state to compare costs

Average Visit Cost

$198
$682

Office visit (CPT 42820)

Compare With Other States

RankStateAverage
1Wisconsin
Range: $95$1,404
$682
2Massachusetts
Range: $219$1,237
$637
3Wyoming
Range: $351$894
$575
4Nebraska
Range: $347$705
$564
5New Hampshire
Range: $290$831
$556
6Georgia
Range: $196$981
$552
7Washington
Range: $324$889
$549
8Maine
Range: $342$578
$498
9North Dakota
Range: $237$820
$485
10Iowa
Range: $95$705
$480
11North Carolina
Range: $217$820
$478
12Rhode Island
Range: $239$742
$474
13District of Columbia
Range: $220$681
$460
14New Mexico
Range: $253$694
$459
15South Dakota
Range: $197$705
$438
16Missouri
Range: $268$559
$436
17Connecticut
Range: $194$742
$432
18New Jersey
Range: $170$833
$425
19Oregon
Range: $85$774
$424
20Vermont
Range: $220$693
$418
21Minnesota
Range: $94$705
$415
22Mississippi
Range: $230$725
$412
23Utah
Range: $85$643
$408
24Alaska
Range: $85$768
$408
25New York
Range: $203$742
$407
26Pennsylvania
Range: $149$742
$402
27Michigan
Range: $238$559
$402
28Illinois
Range: $253$596
$396
29West Virginia
Range: $85$748
$396
30Delaware
Range: $154$698
$390
31Colorado
Range: $85$694
$388
32Alabama
Range: $195$615
$387
33Tennessee
Range: $234$559
$386
34Idaho
Range: $85$679
$384
35Hawaii
Range: $85$665
$383
36South Carolina
Range: $194$644
$381
37Kentucky
Range: $85$679
$374
38Maryland
Range: $226$607
$368
39Virginia
Range: $192$589
$362
40Indiana
Range: $85$649
$360
41Kansas
Range: $268$463
$359
42Louisiana
Range: $189$530
$355
43Oklahoma
Range: $232$540
$354
44California
Range: $80$705
$350
45Arkansas
Range: $85$561
$348
46Texas
Range: $85$597
$332
47Nevada
Range: $228$481
$331
48Montana
Range: $85$581
$326
49Arizona
Range: $240$480
$320
50Ohio
Range: $85$559
$313
51Florida
Range: $35$505
$198
Tonsillectomy in Other States