Cost of a Tonsillectomy Visit
in North Carolina
Reviewed by Momentary Medical Group West PC
North Carolina's healthcare market runs approximately 2% below national averages, reflecting the state's diverse mix of urban medical centers and rural communities. Tonsillectomy procedures in North Carolina typically cost patients between $217 and $820, with a median out-of-pocket expense of $396. The state hosts over 2,250 active tonsillectomy providers across major health systems like Atrium Health, Duke Health, and UNC Health, giving patients substantial choice when browsing all providers in North Carolina.
Average
$478
Median
$396
Lowest
$217
Highest
$820
Providers
2,252
14% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in North Carolina?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,136 | $2,013 | $3,785 | 2,164 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $90 | $1,880 | $3,786 | 2,366 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $390 | $821 | $1,609 | 2,276 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $450 | $795 | $1,504 | 2,192 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $488 | $940 | $1,839 | 2,261 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $776 | $1,655 | 2,518 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,325 | $2,597 | 2,276 |
| Septoplasty Nasal septum repair | 30520 | $500 | $827 | $1,710 | 2,178 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $426 | $698 | $1,453 | 2,159 |
| Mastectomy Partial or simple mastectomy | 19301 | $346 | $831 | $1,713 | 2,257 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $349 | $592 | $1,241 | 2,171 |
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 North Carolina
These hospitals in North Carolina are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
ASHEVILLE, NC
WINSTON-SALEM, NC
SILER CITY, NC
HENDERSONVILLE, NC
DURHAM, NC
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 North Carolina
North Carolina's healthcare costs run approximately 2% below national averages, reflecting the state's balanced economy and moderate cost of living compared to coastal states. The Research Triangle and Charlotte metro areas drive higher pricing due to concentrated academic medical centers and corporate demand.
Urban vs. Rural Provider Availability
Charlotte, Raleigh-Durham, and Greensboro concentrate most of North Carolina's ENT specialists, while rural counties in the eastern and western regions face significant access challenges. Patients from smaller communities often travel 50+ miles to reach qualified tonsillectomy providers. This geographic disparity creates price premiums in underserved areas where limited competition reduces cost pressure.
Facility Type and Overhead Costs
Academic medical centers like Duke University Hospital and UNC Medical Center command premium rates due to teaching hospital overhead and complex case referrals. Independent ambulatory surgery centers throughout North Carolina offer competitive pricing with lower facility fees than hospital-based alternatives. Health system consolidation has concentrated market power among Atrium Health, Novant Health, and the UNC system.
Insurance Market Competition in North Carolina
Blue Cross Blue Shield of North Carolina maintains dominant market share, particularly in rural areas where other insurers have limited provider networks. UnitedHealthcare and Aetna compete primarily in urban markets, creating better rate negotiation leverage for patients in Charlotte and the Research Triangle. Limited insurer competition in smaller markets reduces pressure on providers to offer competitive pricing.
Physician Supply and Demand in North Carolina
With over 2,250 active tonsillectomy providers statewide, North Carolina maintains adequate specialist supply relative to its population of 10.5 million residents. The state's medical schools and residency programs help sustain physician recruitment, though rural areas continue experiencing specialist shortages. Balanced supply and demand conditions support moderate pricing without the premium rates seen in physician shortage areas.
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 North Carolina
What is the average cost of a Tonsillectomy visit in North Carolina without insurance?
Does North Carolina Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in North Carolina?
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 North Carolina?
How does telemedicine affect the cost of seeing a Tonsillectomy in North Carolina?
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 |