Cost of a Tonsillectomy Visit
in Washington
Reviewed by Momentary Medical Group West PC
Washington State's healthcare market runs approximately 10% above national averages, reflecting the region's concentration of major medical centers from Seattle to Spokane. Tonsillectomy patients typically pay between $324 and $889, with a median out-of-pocket cost of $434 across Washington's 2,197 active providers. The state's robust provider network spans from urban academic medical centers in King County to rural facilities serving eastern Washington communities, giving patients multiple options for accessing specialized ear, nose, and throat care.
Average
$549
Median
$434
Lowest
$324
Highest
$889
Providers
2,197
31% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Washington?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,606 | $2,114 | $3,703 | 2,174 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $1,500 | $2,037 | $3,707 | 2,234 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $616 | $966 | $1,521 | 2,220 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $80 | $764 | $1,475 | 4,308 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $80 | $806 | $1,815 | 5,408 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $794 | $1,832 | 5,463 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $985 | $1,415 | $2,480 | 2,213 |
| Septoplasty Nasal septum repair | 30520 | $80 | $857 | $1,793 | 4,297 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $592 | $768 | $1,594 | 2,162 |
| Mastectomy Partial or simple mastectomy | 19301 | $585 | $946 | $1,804 | 2,200 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $490 | $669 | $1,221 | 2,180 |
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 Washington
These hospitals in Washington are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
SPOKANE, WA
CLARKSTON, WA
PULLMAN, WA
PORT TOWNSEND, WA
PROSSER, WA
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 Washington
Washington's healthcare costs run approximately 10% above the national average, driven by high living costs in the Puget Sound region and limited provider competition in rural eastern counties. The state's geography creates stark disparities between Seattle's premium medical market and more affordable options in smaller communities like Yakima or Bellingham.
Urban vs. Rural Provider Availability
Seattle and surrounding King County concentrate the majority of Washington's ENT specialists, creating premium pricing but shorter wait times for tonsillectomy procedures. Rural areas east of the Cascades often require patients to travel 2-3 hours to reach specialized surgical centers, though these facilities typically offer more competitive pricing. Spokane serves as the primary ENT hub for eastern Washington, with costs generally 15-25% lower than Seattle-area practices.
Facility Type and Overhead Costs
Major health systems like UW Medicine, Swedish, and Virginia Mason operate high-overhead hospital-based surgery centers that typically charge premium rates for tonsillectomy procedures. Independent ENT practices and ambulatory surgery centers often provide the same surgical quality at 20-30% lower costs due to reduced facility fees. MultiCare and CHI Franciscan systems serve as mid-tier options between premium academic centers and independent practices.
Insurance Market Competition in Washington
Premera Blue Cross and Regence BlueShield dominate Washington's individual and employer markets, while Kaiser Permanente operates an integrated model primarily in western Washington. This moderate competition among four major carriers (including UnitedHealthcare) creates reasonably negotiated rates for surgical procedures compared to less competitive state markets. Rural areas may have limited insurer choices, potentially affecting negotiated rates for tonsillectomy services.
Physician Supply and Demand in Washington
Washington's 2,197 active tonsillectomy providers create adequate supply in urban areas but potential shortages in rural counties east of the Cascades. The concentration of medical training programs in Seattle produces steady ENT specialist supply, helping moderate pricing pressure compared to states with physician shortages. However, demand for pediatric tonsillectomy has increased due to growing recognition of sleep apnea in children, potentially extending wait times at specialized pediatric centers.
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 Washington
What is the average cost of a Tonsillectomy visit in Washington without insurance?
Does Washington Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Washington?
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 Washington?
How does telemedicine affect the cost of seeing a Tonsillectomy in Washington?
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 |