Cost of a Tonsillectomy Visit
in Rhode Island
Reviewed by Momentary Medical Group West PC
Rhode Island's compact healthcare market, dominated by three major health systems serving just over one million residents, creates a unique cost environment for specialized surgical procedures. Tonsillectomy patients typically pay between $239 and $742, with a median out-of-pocket cost of $441, reflecting negotiated rates that run approximately 16% above national averages. With 58 active Tonsillectomy providers across the Ocean State, patients can browse all available specialists to find quality care that fits their budget.
Average
$474
Median
$441
Lowest
$239
Highest
$742
Providers
58
13% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Rhode Island?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,136 | $2,323 | $6,051 | 57 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $80 | $1,978 | $6,060 | 74 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $448 | $960 | $2,135 | 58 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $452 | $895 | $2,410 | 58 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $91 | $1,006 | $1,921 | 66 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $884 | $1,752 | 79 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,277 | $3,201 | 60 |
| Septoplasty Nasal septum repair | 30520 | $555 | $1,052 | $2,160 | 56 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $440 | $858 | $1,521 | 57 |
| Mastectomy Partial or simple mastectomy | 19301 | $509 | $1,087 | $2,642 | 61 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $364 | $877 | $1,957 | 58 |
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 Rhode Island
Rhode Island's healthcare costs run approximately 13% above national averages, reflecting the state's high cost of living and concentration of academic medical centers within a small geographic area. The Ocean State's unique position as the smallest state creates an interesting dynamic where urban healthcare infrastructure serves the entire population without true rural access challenges.
Urban vs. Rural Provider Availability
Rhode Island's compact 1,214 square miles mean that even residents in rural areas like Westerly or Block Island remain within reasonable driving distance of Providence's major medical centers. This geographic advantage eliminates the typical urban-rural cost disparities seen in larger states, though it also means less price competition between distant markets.
Facility Type and Overhead Costs
Hospital-based outpatient surgery centers affiliated with Lifespan, Care New England, or Prospect CharterCARE typically charge higher facility fees than independent ambulatory surgery centers due to different overhead structures and academic affiliations. The concentration of teaching hospitals in Providence creates a higher-cost environment that influences pricing throughout the state's interconnected healthcare system.
Insurance Market Competition in Rhode Island
The dominance of Blue Cross Blue Shield of Rhode Island, UnitedHealthcare, and Tufts Health Plan creates a moderately competitive environment where negotiated rates remain relatively stable but limited insurer options can result in higher baseline costs. This concentrated market structure means provider leverage in rate negotiations varies significantly based on their relationships with these three key payers.
Physician Supply and Demand in Rhode Island
With 58 active Tonsillectomy providers serving just over one million residents, Rhode Island maintains adequate specialist availability without the severe shortages affecting rural states. This balanced supply-demand ratio contributes to reasonable wait times but doesn't create the pricing pressure that physician oversupply might generate in larger metropolitan markets.
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 Rhode Island
What is the average cost of a Tonsillectomy visit in Rhode Island without insurance?
Does Rhode Island Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Rhode Island?
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 Rhode Island?
How does telemedicine affect the cost of seeing a Tonsillectomy in Rhode Island?
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 |