Cost of a Tonsillectomy Visit
in Tennessee
Reviewed by Momentary Medical Group West PC
Tennessee's healthcare costs run approximately 4% below the national average, making surgical procedures like tonsillectomies more affordable than many neighboring states. Tonsillectomy patients typically pay between $233 and $559, with a median out-of-pocket cost of $364 based on negotiated insurance rates across Tennessee's 2,379 active providers. Patients can browse all tonsillectomy-performing surgeons throughout Tennessee to find the most cost-effective option for their needs.
Average
$386
Median
$364
Lowest
$234
Highest
$559
Providers
2,379
8% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Tennessee?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,147 | $1,734 | $2,647 | 2,258 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $1,095 | $1,701 | $2,579 | 2,352 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $418 | $715 | $1,090 | 2,391 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $466 | $690 | $1,057 | 2,276 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $531 | $835 | $1,300 | 2,318 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $90 | $748 | $1,258 | 2,637 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,116 | $1,679 | 2,384 |
| Septoplasty Nasal septum repair | 30520 | $516 | $732 | $1,155 | 2,275 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $440 | $660 | $1,016 | 2,254 |
| Mastectomy Partial or simple mastectomy | 19301 | $371 | $763 | $1,198 | 2,374 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $332 | $503 | $804 | 2,426 |
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 Tennessee
These hospitals in Tennessee are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
MOUNTAIN HOME, TN
MANCHESTER, TN
HUNTINGDON, TN
FRANKLIN, TN
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 Tennessee
Tennessee healthcare costs run roughly 4% below national averages, reflecting the state's lower cost of living and competitive provider market across major metropolitan areas. The state's geographic diversity creates significant cost variations between urban centers like Nashville's medical corridor and rural Appalachian communities with limited specialist access.
Urban vs. Rural Provider Availability
Tennessee's ENT specialists concentrate heavily in Nashville, Memphis, Knoxville, and Chattanooga, creating cost premiums in these metropolitan markets while leaving rural counties with limited local options. Patients in rural East Tennessee often travel significant distances to access pediatric ENT specialists, sometimes driving costs higher due to facility overhead at regional medical centers.
Facility Type and Overhead Costs
Hospital-owned ENT clinics affiliated with major Tennessee health systems like Vanderbilt, Baptist, and TriStar typically charge higher facility fees compared to independent surgical practices. These academic and large health system facilities often justify premium pricing through subspecialty expertise and advanced surgical technology, though the clinical outcomes may be comparable for routine tonsillectomies.
Insurance Market Competition in Tennessee
Tennessee's moderate insurer competition among BCBS Tennessee, UnitedHealthcare, and Cigna creates relatively balanced negotiated rates for surgical procedures, preventing the extreme pricing seen in single-insurer dominated markets. However, BCBS Tennessee's dominant market position in rural counties can limit competitive pricing pressure compared to urban areas with multiple insurer options.
Physician Supply and Demand in Tennessee
With 2,379 active tonsillectomy providers throughout Tennessee, the state maintains adequate ENT surgeon supply relative to population, helping moderate pricing compared to shortage markets. This robust provider network includes both general ENT surgeons and pediatric subspecialists, creating competitive options for families while maintaining reasonable wait times for non-emergency tonsillectomy procedures.
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 Tennessee
What is the average cost of a Tonsillectomy visit in Tennessee without insurance?
Does Tennessee Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Tennessee?
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 Tennessee?
How does telemedicine affect the cost of seeing a Tonsillectomy in Tennessee?
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 |