Cost of a Tonsillectomy Visit
in Utah
Reviewed by Momentary Medical Group West PC
Utah's healthcare system serves a rapidly growing population with one of the youngest median ages in the nation, creating strong demand for pediatric and adult tonsillectomy services across the state. Tonsillectomy patients typically pay between $85 and $643, with a median out-of-pocket cost of $497 based on negotiated insurance rates from 356 active providers throughout Utah. Browse all providers in Utah to compare costs and find the right fit for your needs.
Average
$408
Median
$497
Lowest
$85
Highest
$643
Providers
356
3% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Utah?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $842 | $2,803 | $2,906 | 318 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $90 | $2,808 | $2,909 | 330 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $1,079 | $1,209 | 368 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $80 | $1,157 | $1,294 | 337 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $80 | $1,309 | $1,513 | 352 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $975 | $1,321 | 405 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,452 | $1,994 | 354 |
| Septoplasty Nasal septum repair | 30520 | $90 | $1,368 | $1,485 | 322 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $374 | $1,126 | $1,150 | 315 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $1,363 | $1,449 | 354 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $265 | $930 | $988 | 314 |
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 Utah
These hospitals in Utah are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
HEBER CITY, UT
CEDAR CITY, UT
NORTH LOGAN, UT
ST GEORGE, UT
PARK CITY, UT
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 Utah
Utah's healthcare costs run approximately 2% below the national average, reflecting the state's efficient healthcare delivery and competitive insurance market. The concentration of medical facilities along the Wasatch Front creates cost efficiencies, while rural areas face higher per-procedure costs due to lower patient volumes.
Urban vs. Rural Provider Availability
The Salt Lake City metropolitan area and Wasatch Front corridor contain most of Utah's ENT specialists, creating competitive pricing and shorter wait times for tonsillectomy procedures. Rural counties like San Juan, Piute, and Rich often require patients to travel significant distances for specialized care, potentially adding travel costs but sometimes finding lower base procedure fees. Telemedicine consultations are increasingly used for pre- and post-operative care in remote areas.
Facility Type and Overhead Costs
Hospital-based outpatient surgical centers, particularly those affiliated with Intermountain Healthcare and University of Utah Health, typically charge higher facility fees due to their comprehensive infrastructure and 24/7 capabilities. Independent ambulatory surgery centers throughout Utah often offer more competitive pricing for routine tonsillectomies, with overhead costs that are 30-50% lower than hospital facilities. These cost differences directly impact what patients pay out-of-pocket.
Insurance Market Competition in Utah
SelectHealth, Blue Cross Blue Shield of Utah, and UnitedHealthcare maintain competitive market positions, leading to reasonable negotiated rates with ENT providers across the state. The relatively concentrated insurance market allows for effective rate negotiations, though patients should still compare costs as rates can vary significantly between plans. Utah's lack of an all-payer claims database means price transparency relies on individual insurer reporting.
Physician Supply and Demand in Utah
With 356 active tonsillectomy providers serving Utah's growing population, the state maintains adequate specialist availability in urban areas while facing shortages in rural regions. This supply-demand balance keeps procedure costs reasonable in competitive markets like Salt Lake City, while rural areas may experience higher costs due to limited provider options. Wait times for non-urgent tonsillectomies typically range from 2-6 weeks depending on location and surgeon preference.
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 Utah
What is the average cost of a Tonsillectomy visit in Utah without insurance?
Does Utah Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Utah?
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 Utah?
How does telemedicine affect the cost of seeing a Tonsillectomy in Utah?
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 |