Cost of a Tonsillectomy Visit
in Maryland
Reviewed by Momentary Medical Group West PC
Maryland's regulated hospital rate-setting system and concentrated insurer market create unique pricing patterns for surgical procedures across the state. Tonsillectomy patients in Maryland typically pay between $226 and $607, with a median cost of $271 based on negotiated insurance rates from nearly 4,000 active providers. Maryland residents benefit from strong provider density and competitive options when selecting an ENT surgeon for tonsillectomy procedures.
Average
$368
Median
$271
Lowest
$226
Highest
$607
Providers
3,971
12% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Maryland?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,204 | $1,365 | $3,475 | 3,921 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $1,124 | $1,289 | $2,667 | 3,950 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $477 | $581 | $1,083 | 3,982 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $485 | $559 | $1,591 | 3,923 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $545 | $633 | $1,355 | 3,993 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $437 | $573 | $1,238 | 4,028 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $754 | $892 | $1,779 | 4,051 |
| Septoplasty Nasal septum repair | 30520 | $461 | $617 | $1,395 | 3,925 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $381 | $498 | $1,079 | 3,919 |
| Mastectomy Partial or simple mastectomy | 19301 | $346 | $626 | $1,292 | 3,976 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $318 | $419 | $920 | 3,931 |
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.
Why Tonsillectomy Visit Costs Vary Across Maryland
Maryland's healthcare costs run approximately 13% above the national average, driven by proximity to the high-cost Washington D.C. metro area and the state's regulated hospital pricing system. The concentration of academic medical centers and federal healthcare facilities creates a premium pricing environment, particularly in Baltimore and suburban Maryland counties.
Urban vs. Rural Provider Availability
The Baltimore-Washington corridor contains most of Maryland's ENT specialists, while the Eastern Shore and Western Maryland counties have limited local options for tonsillectomy procedures. Rural patients often travel to Salisbury, Frederick, or Hagerstown for specialist care, with some choosing Baltimore or D.C. area academic centers. This geographic concentration allows urban providers to command higher rates due to convenience factors.
Facility Type and Overhead Costs
Hospital-owned ENT practices affiliated with Johns Hopkins, University of Maryland Medical System, and MedStar Health typically charge facility fees that increase total procedure costs. Independent ambulatory surgery centers in Maryland offer competitive rates but may have more limited insurance contracts. Academic medical centers justify premium pricing through resident training programs and complex case capabilities.
Insurance Market Competition in Maryland
CareFirst BlueCross BlueShield's dominant market position gives it significant negotiating leverage with Maryland providers, resulting in favorable rates for members. United Healthcare and Aetna compete primarily in the employer market, while smaller insurers like Kaiser Permanente operate integrated delivery models. Limited insurer competition in rural Maryland counties can result in higher negotiated rates due to reduced market pressure.
Physician Supply and Demand in Maryland
Nearly 4,000 providers perform tonsillectomy procedures in Maryland, indicating strong specialist availability relative to the state's 6 million residents. This robust supply helps moderate pricing in competitive markets like Baltimore and Montgomery County. However, subspecialty pediatric ENT surgeons remain concentrated at major academic centers, potentially creating premium pricing for complex cases.
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 Maryland
What is the average cost of a Tonsillectomy visit in Maryland without insurance?
Does Maryland Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Maryland?
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 Maryland?
How does telemedicine affect the cost of seeing a Tonsillectomy in Maryland?
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 |