Cost of a Tonsillectomy Visit
in New Jersey
Reviewed by Momentary Medical Group West PC
New Jersey's dense network of academic medical centers and suburban specialty practices creates a competitive market for surgical procedures like tonsillectomy. Based on insurance negotiated rates, patients typically pay between $170 and $833 for tonsillectomy services, with a median cost of $273. The Garden State has over 6,500 active providers offering tonsillectomy services across its 21 counties, giving patients substantial choice when selecting a surgeon.
Average
$425
Median
$273
Lowest
$170
Highest
$833
Providers
6,523
1% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in New Jersey?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $952 | $1,422 | $4,588 | 6,486 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $953 | $1,424 | $4,590 | 6,528 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $364 | $625 | $1,380 | 6,526 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $412 | $578 | $1,845 | 6,494 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $388 | $664 | $1,827 | 6,521 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $340 | $546 | $1,669 | 6,585 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $627 | $1,045 | $2,093 | 6,519 |
| Septoplasty Nasal septum repair | 30520 | $406 | $566 | $1,411 | 6,484 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $309 | $475 | $1,435 | 6,484 |
| Mastectomy Partial or simple mastectomy | 19301 | $314 | $558 | $1,446 | 6,513 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $265 | $519 | $2,119 | 6,490 |
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 New Jersey
These hospitals in New Jersey are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
BROWNS MILLS, NJ
MORRISTOWN, NJ
ENGLEWOOD, NJ
PLAINSBORO, NJ
PARAMUS, NJ
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 New Jersey
New Jersey's healthcare costs run approximately 17% above national averages, reflecting the state's high cost of living and concentration of academic medical centers. The Garden State's dense population and proximity to major metropolitan areas create unique pricing dynamics for surgical procedures.
Urban vs. Rural Provider Availability
Northern New Jersey's proximity to New York City creates higher surgical costs, while South Jersey and rural areas offer more affordable options. The concentration of major medical centers in Newark, New Brunswick, and Camden drives competition but also elevates baseline pricing. Patients often find significant savings by choosing providers in less densely populated counties.
Facility Type and Overhead Costs
Hospital-based outpatient surgery centers at institutions like Robert Wood Johnson and Hackensack Meridian carry higher overhead costs than independent surgical facilities. Academic medical centers throughout New Jersey typically charge premium rates due to their teaching hospital status and advanced technology investments. Ambulatory surgery centers often provide identical tonsillectomy outcomes at substantially lower costs.
Insurance Market Competition in New Jersey
Horizon Blue Cross Blue Shield, Aetna, and UnitedHealthcare dominate New Jersey's insurance market, creating moderate competition that benefits consumers. The state's relatively concentrated insurer market allows for stronger negotiated rate agreements with surgical providers. Regional insurers and self-funded employer plans sometimes offer more competitive rates for elective procedures like tonsillectomy.
Physician Supply and Demand in New Jersey
With over 6,500 providers offering tonsillectomy services, New Jersey maintains adequate surgical capacity relative to its population of 9.3 million residents. This healthy provider supply helps moderate pricing and reduces wait times for non-urgent cases. The state's medical schools and residency programs continuously train new ENT surgeons, maintaining competitive market conditions.
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 New Jersey
What is the average cost of a Tonsillectomy visit in New Jersey without insurance?
Does New Jersey Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in New Jersey?
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 New Jersey?
How does telemedicine affect the cost of seeing a Tonsillectomy in New Jersey?
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 |