Cost of a Tonsillectomy Visit
in New York
Reviewed by Momentary Medical Group West PC
New York's concentration of academic medical centers and teaching hospitals creates one of the most competitive ENT surgery markets in the nation, with over 30,000 Tonsillectomy providers serving patients statewide. Patients typically pay between $203 and $742 for tonsillectomy procedures, with a median cost of $276 based on negotiated insurance rates. Browse all Tonsillectomy providers across New York to compare costs and find the right surgeon for your needs.
Average
$407
Median
$276
Lowest
$203
Highest
$742
Providers
30,860
3% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in New York?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $898 | $1,288 | $6,051 | 30,852 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $900 | $1,289 | $6,060 | 30,927 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $364 | $515 | $2,135 | 30,876 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $384 | $538 | $2,410 | 30,865 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $452 | $638 | $1,820 | 30,954 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $412 | $577 | $1,655 | 31,025 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $627 | $890 | $3,201 | 30,796 |
| Septoplasty Nasal septum repair | 30520 | $466 | $625 | $2,160 | 30,844 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $364 | $504 | $1,435 | 30,842 |
| Mastectomy Partial or simple mastectomy | 19301 | $452 | $609 | $2,642 | 30,775 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $320 | $622 | $1,963 | 30,846 |
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 York
These hospitals in New York are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
ELIZABETHTOWN, NY
SARANAC LAKE, NY
NEW YORK, NY
WALTON, NY
ROSLYN, NY
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 York
New York's healthcare costs run approximately 22% above national averages, driven by the concentration of world-renowned medical centers in Manhattan and high operational costs throughout the metropolitan area. The state's unique geography creates dramatic cost variations between premium NYC facilities and more affordable options in Albany, Rochester, and Buffalo regions.
Urban vs. Rural Provider Availability
The NYC metropolitan area hosts over 60% of the state's ENT surgeons despite serving only 40% of the population, creating access challenges and higher costs in rural counties like Hamilton and Essex. Upstate patients often travel 2-3 hours to reach specialized pediatric ENT centers, though telemedicine consultations are increasingly available for initial evaluations and post-operative care.
Facility Type and Overhead Costs
Hospital-owned surgical centers in Manhattan can charge facility fees 2-3 times higher than independent surgery centers in outer boroughs due to their academic medical center status and research overhead. Major health systems like NewYork-Presbyterian and NYU Langone operate multiple facilities with varying cost structures, allowing patients to choose between premium Manhattan locations and more affordable satellite centers.
Insurance Market Competition in New York
Strong competition between Empire BCBS, UnitedHealthcare, Aetna, and Cigna has created relatively balanced negotiated rates compared to states with single dominant insurers. The state's rigorous insurance regulation and active marketplace competition help prevent the extreme rate variations seen in less regulated markets, though premium facility designations still command higher reimbursements.
Physician Supply and Demand in New York
With over 30,000 active Tonsillectomy providers statewide, New York maintains one of the highest surgeon-to-population ratios in the country, particularly benefiting pediatric patients who require specialized care. This robust supply helps moderate pricing pressure and reduces wait times, though the highest-rated surgeons at premier institutions often maintain 4-6 week scheduling delays.
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 York
What is the average cost of a Tonsillectomy visit in New York without insurance?
Does New York Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in New York?
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 York?
How does telemedicine affect the cost of seeing a Tonsillectomy in New York?
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 |