Cost of a Tonsillectomy Visit
in Vermont
Reviewed by Momentary Medical Group West PC
Vermont's rural healthcare landscape, where 61% of the state is considered medically underserved, creates unique challenges for accessing specialty care like tonsillectomy procedures. Based on negotiated insurance rates, patients typically pay between $220 and $693 for tonsillectomy services, with a median cost of $342 across Vermont's 324 active providers. You can browse all tonsillectomy specialists throughout Vermont to compare costs and find the right provider for your needs.
Average
$418
Median
$342
Lowest
$220
Highest
$693
Providers
324
0% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Vermont?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $958 | $1,455 | $3,286 | 326 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $959 | $1,457 | $3,289 | 329 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $403 | $643 | $1,548 | 325 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $410 | $629 | $1,326 | 331 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $492 | $746 | $1,597 | 331 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $449 | $682 | $1,463 | 337 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $678 | $1,043 | $2,143 | 325 |
| Septoplasty Nasal septum repair | 30520 | $500 | $821 | $1,577 | 327 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $391 | $596 | $1,271 | 325 |
| Mastectomy Partial or simple mastectomy | 19301 | $491 | $749 | $1,593 | 324 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $338 | $519 | $1,053 | 324 |
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 Vermont
Vermont's healthcare costs run approximately 15% above national averages, reflecting the state's rural geography and limited provider competition in specialized services like tonsillectomy. The Green Mountain State's scattered population across mountainous terrain creates unique access challenges that influence both pricing and availability of ENT surgical services.
Urban vs. Rural Provider Availability
The Burlington metropolitan area concentrates most of Vermont's ENT specialists, while rural counties like Essex and Grand Isle have no resident otolaryngologists, forcing patients to travel significant distances. This geographic maldistribution drives up costs as rural patients often face higher travel expenses and limited appointment availability. Chittenden County offers the most competitive pricing due to provider density, while rural regions may have fewer cost comparison options.
Facility Type and Overhead Costs
The University of Vermont Medical Center dominates the state's healthcare landscape, with many ENT services delivered through hospital-owned outpatient centers that typically charge facility fees. Independent surgical centers offer alternatives in the Burlington area but are scarce in rural Vermont. Hospital-based practices generally have higher overhead costs that are passed along to patients, while smaller independent practices may offer more flexible pricing structures.
Insurance Market Competition in Vermont
With primarily BCBS Vermont and MVP Health Care controlling the majority of the commercial insurance market, negotiated rates for tonsillectomy services have limited variation between major payers. This concentrated market structure means fewer competitive pressures on pricing compared to states with more diverse insurer participation. The state's small population and regulatory environment contribute to higher administrative costs that affect overall healthcare pricing.
Physician Supply and Demand in Vermont
Vermont's 324 active tonsillectomy providers serve a population of just over 640,000, creating a relatively adequate supply ratio compared to national averages. However, the geographic distribution remains problematic, with most specialists concentrated in Chittenden and Washington counties. This supply-demand dynamic means shorter wait times in urban areas but potentially higher costs due to travel requirements for rural patients seeking care.
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 Vermont
What is the average cost of a Tonsillectomy visit in Vermont without insurance?
Does Vermont Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Vermont?
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 Vermont?
How does telemedicine affect the cost of seeing a Tonsillectomy in Vermont?
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 |