Cost of a Tonsillectomy Visit
in Maine
Reviewed by Momentary Medical Group West PC
Maine's rural geography means many residents travel significant distances for specialized surgical care, with tonsillectomy procedures often concentrated in larger medical centers around Portland and Bangor. While specific out-of-pocket costs vary by insurance plan, negotiated rates for tonsillectomy procedures (CPT 42820) in Maine range from $341.70 to $578.44, with providers across the state accepting various insurance plans. Maine patients can browse from over 1,500 tonsillectomy providers to find the most affordable option for their surgical needs.
Average
$498
Median
$573
Lowest
$342
Highest
$578
Providers
1,524
19% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Maine?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,713 | $2,488 | $2,689 | 1,522 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $1,585 | $2,491 | $2,639 | 1,529 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $643 | $1,068 | $1,123 | 1,524 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $634 | $1,054 | $1,087 | 1,528 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $746 | $1,250 | $1,286 | 1,541 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $682 | $1,144 | $1,177 | 1,551 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $1,043 | $1,716 | $1,776 | 1,529 |
| Septoplasty Nasal septum repair | 30520 | $811 | $1,310 | $1,346 | 1,526 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $630 | $998 | $1,022 | 1,521 |
| Mastectomy Partial or simple mastectomy | 19301 | $749 | $1,255 | $1,274 | 1,523 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $519 | $850 | $888 | 1,519 |
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 Maine
These hospitals in Maine are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
AUGUSTA, ME
HOULTON, ME
BANGOR, ME
PORTLAND, ME
BAR HARBOR, ME
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 Maine
Healthcare costs in Maine run approximately 12% above national averages, reflecting the state's rural geography and limited provider competition in many regions. The concentration of major medical facilities in southern Maine creates cost disparities between urban and rural areas for specialized surgical procedures.
Urban vs. Rural Provider Availability
Most tonsillectomy procedures in Maine are performed in the Portland metro area and other larger cities, requiring rural patients to travel considerable distances for surgery. This geographic concentration allows urban facilities to maintain higher procedure volumes but may limit price competition in underserved regions.
Facility Type and Overhead Costs
Large health systems like MaineHealth and Northern Light Health operate most surgical facilities performing tonsillectomies in Maine, with their hospital-based outpatient centers typically charging higher facility fees than independent surgical centers. These major systems' overhead costs and teaching responsibilities often translate to higher negotiated rates with insurers.
Insurance Market Competition in Maine
The limited number of major insurers in Maine - primarily Anthem, Harvard Pilgrim, and UHC - creates less competitive pressure on negotiated rates for surgical procedures. This concentrated insurance market can result in higher costs for patients compared to states with more robust insurer competition.
Physician Supply and Demand in Maine
With over 1,500 providers offering tonsillectomy services, Maine has reasonable access to ENT surgeons relative to its population size. However, the geographic distribution favors urban areas, potentially creating longer wait times and higher costs in rural regions where specialist availability is more limited.
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 Maine
What is the average cost of a Tonsillectomy visit in Maine without insurance?
Does Maine Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Maine?
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 Maine?
How does telemedicine affect the cost of seeing a Tonsillectomy in Maine?
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 |