Cost of a Tonsillectomy Visit
in Oregon
Reviewed by Momentary Medical Group West PC
Oregon's healthcare costs run approximately 9% above national averages, driven by concentrated provider networks in Portland metro and limited specialist access in rural eastern counties. Tonsillectomy patients typically pay between $85 and $774, with a median out-of-pocket cost of $413 based on negotiated insurance rates from 176 active providers across the state. Browse all tonsillectomy specialists throughout Oregon to compare costs and find in-network options in your area.
Average
$424
Median
$413
Lowest
$85
Highest
$774
Providers
176
1% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Oregon?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,116 | $2,114 | $3,635 | 165 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $90 | $1,921 | $3,637 | 201 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $803 | $1,687 | 188 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $80 | $763 | $1,591 | 250 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $80 | $751 | $1,770 | 326 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $745 | $1,616 | 366 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,271 | $3,201 | 186 |
| Septoplasty Nasal septum repair | 30520 | $80 | $843 | $1,641 | 243 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $440 | $758 | $1,399 | 156 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $934 | $1,746 | 180 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $90 | $643 | $1,930 | 170 |
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 Oregon
Oregon's healthcare costs run approximately 9% above national averages, reflecting the state's concentration of providers in metro areas and limited competition in rural markets. The Columbia River Gorge and eastern Oregon counties face particular cost pressures due to specialist shortages and patient travel requirements for specialized ENT care.
Urban vs. Rural Provider Availability
Portland metro contains roughly 70% of Oregon's ENT specialists despite serving only half the state's population, creating significant access disparities for rural patients. Eastern Oregon residents often travel 2-3 hours to reach tonsillectomy specialists, with some choosing Idaho or Washington providers for convenience. This geographic maldistribution inflates costs for rural patients who must factor in travel, lodging, and lost wages alongside medical expenses.
Facility Type and Overhead Costs
Oregon Health & Science University and Legacy Health dominate Portland's ENT landscape, with hospital-owned practices typically charging 25-40% more than independent specialists due to facility fees and administrative overhead. Ambulatory surgery centers have gained popularity for outpatient tonsillectomy procedures, often providing significant cost savings compared to hospital operating rooms. Salem and Eugene markets offer more independent practice options, potentially reducing overall procedure costs.
Insurance Market Competition in Oregon
Regence BCBS, PacificSource, and UHC control approximately 75% of Oregon's commercial insurance market, creating relatively concentrated negotiating power with healthcare providers. Rural areas often have limited insurer choices, reducing competitive pressure on provider rates outside metro Portland. The state's lack of an all-payer claims database limits price transparency, making it difficult for patients to comparison shop effectively.
Physician Supply and Demand in Oregon
With 176 active tonsillectomy providers serving 4.2 million residents, Oregon maintains adequate ENT specialist density in urban areas but faces shortages in rural counties. This supply-demand imbalance allows urban specialists to command premium rates while rural patients face limited choices and potentially higher travel-inclusive costs. Wait times for elective tonsillectomy procedures average 3-6 weeks in Portland versus 8-12 weeks in rural areas, reflecting both demand pressures and provider availability.
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 Oregon
What is the average cost of a Tonsillectomy visit in Oregon without insurance?
Does Oregon Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Oregon?
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 Oregon?
How does telemedicine affect the cost of seeing a Tonsillectomy in Oregon?
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 |