Cost of a Tonsillectomy Visit
in Pennsylvania
Reviewed by Momentary Medical Group West PC
Pennsylvania's healthcare costs run approximately 9% above national averages, driven by concentrated markets in Philadelphia and Pittsburgh alongside extensive rural coverage areas. Tonsillectomy patients typically pay between $148 and $741, with a median out-of-pocket cost of $317 based on negotiated insurance rates across 968 active providers statewide. The Commonwealth maintains a robust network of ENT specialists serving both major metropolitan areas and smaller communities, allowing patients to browse providers throughout Pennsylvania's diverse healthcare landscape.
Average
$402
Median
$317
Lowest
$149
Highest
$742
Providers
968
4% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Pennsylvania?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $909 | $1,551 | $6,051 | 916 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $80 | $1,379 | $6,060 | 1,270 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $618 | $2,135 | 984 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $366 | $623 | $2,410 | 933 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $98 | $709 | $1,984 | 1,021 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $632 | $1,669 | 1,389 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $975 | $3,201 | 983 |
| Septoplasty Nasal septum repair | 30520 | $434 | $719 | $2,160 | 910 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $333 | $562 | $1,448 | 914 |
| Mastectomy Partial or simple mastectomy | 19301 | $250 | $705 | $2,642 | 976 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $317 | $537 | $1,957 | 914 |
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 Pennsylvania
These hospitals in Pennsylvania are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
WASHINGTON, PA
ROYERSFORD, PA
YORK, PA
WYOMISSING, PA
MUNCY, PA
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 Pennsylvania
Pennsylvania's healthcare costs exceed national averages by roughly 9%, reflecting the state's mix of expensive urban markets and costly rural service delivery across mountainous terrain. The concentration of major health systems in Philadelphia and Pittsburgh creates pricing power, while smaller communities face limited provider competition and higher overhead costs.
Urban vs. Rural Provider Availability
Philadelphia and Pittsburgh metro areas offer abundant ENT specialists and competitive pricing, while rural counties in central and northern Pennsylvania may have limited options requiring longer travel distances. This geographic disparity affects both access and cost, with rural patients sometimes paying more for the same services available more affordably in urban centers.
Facility Type and Overhead Costs
Hospital-owned ENT clinics affiliated with UPMC, Penn Medicine, and Geisinger typically charge higher facility fees compared to independent practices, reflecting institutional overhead and academic medical center costs. Community-based ENT groups often provide more competitive pricing while maintaining quality care standards throughout Pennsylvania's diverse markets.
Insurance Market Competition in Pennsylvania
Highmark dominates western Pennsylvania while Independence Blue Cross leads in the southeast, with UnitedHealthcare providing statewide competition that helps moderate negotiated rates. This regional insurer concentration means provider networks and pricing vary significantly between Pittsburgh and Philadelphia markets, affecting patient choice and costs.
Physician Supply and Demand in Pennsylvania
With 968 active tonsillectomy providers across the state, Pennsylvania maintains adequate ENT specialist availability relative to its population, though distribution favors urban areas over rural regions. This reasonable supply helps moderate pricing compared to specialist-shortage states, though wait times for non-urgent procedures can extend several weeks in popular practices.
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 Pennsylvania
What is the average cost of a Tonsillectomy visit in Pennsylvania without insurance?
Does Pennsylvania Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Pennsylvania?
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 Pennsylvania?
How does telemedicine affect the cost of seeing a Tonsillectomy in Pennsylvania?
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 |