Cost of a Tonsillectomy Visit
in Montana
Reviewed by Momentary Medical Group West PC
Montana's vast rural landscape and limited specialist concentration create unique challenges for patients seeking surgical care like tonsillectomy procedures. Tonsillectomy costs in the state range from $85 to $581, with a median negotiated rate of $313 based on transparency data from 38 active providers across Montana. Patients can browse all participating Tonsillectomy providers throughout the state to find the most affordable option for their specific insurance plan.
Average
$326
Median
$313
Lowest
$85
Highest
$581
Providers
38
22% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Montana?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $92 | $1,667 | $6,877 | 35 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $80 | $1,395 | $6,442 | 49 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $554 | $2,744 | 48 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $80 | $80 | $985 | 300 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $80 | $80 | $1,124 | 315 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $80 | $1,231 | 321 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $82 | $983 | $4,679 | 42 |
| Septoplasty Nasal septum repair | 30520 | $80 | $80 | $920 | 298 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $378 | $656 | $2,328 | 32 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $675 | $2,902 | 39 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $90 | $469 | $979 | 37 |
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 Montana
These hospitals in Montana are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
FORT HARRISON, MT
WHITEFISH, MT
MISSOULA, MT
ANACONDA, MT
GREAT FALLS, MT
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 Montana
Montana's healthcare costs run approximately 4% above national averages, reflecting the challenges of delivering specialized care across the nation's fourth-largest state. The state's extreme rural geography concentrates most ENT specialists in Billings, Missoula, and Great Falls, creating access barriers for patients in frontier communities.
Urban vs. Rural Provider Availability
Montana's 38 active tonsillectomy providers are heavily concentrated in urban corridors along Interstate highways, leaving vast rural areas underserved. Patients in eastern Montana may need to travel over 200 miles to reach an ENT surgeon, often necessitating overnight stays that add to total treatment costs.
Facility Type and Overhead Costs
Hospital-owned ENT clinics dominate Montana's major cities, with systems like Billings Clinic and Providence St. Patrick maintaining the largest surgical programs. Independent ENT practices are rare due to the high overhead costs of maintaining surgical equipment and staff in Montana's low-population-density market.
Insurance Market Competition in Montana
BCBS Montana, PacificSource, and UHC represent the primary commercial insurers, with relatively limited competition compared to more populous states. This moderate insurer concentration can result in less aggressive rate negotiations with providers, contributing to Montana's above-average healthcare costs.
Physician Supply and Demand in Montana
With 38 active tonsillectomy providers serving over one million residents, Montana faces a moderate shortage of ENT specialists relative to national ratios. This supply constraint allows surgeons to maintain higher fees and longer wait times, particularly for non-urgent tonsillectomy procedures in adult patients.
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 Montana
What is the average cost of a Tonsillectomy visit in Montana without insurance?
Does Montana Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Montana?
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 Montana?
How does telemedicine affect the cost of seeing a Tonsillectomy in Montana?
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 |