Tonsillectomy: what it covers and what it costs
What does a Tonsillectomy cost? Across 31 major U.S. metros, the typical insurer-negotiated price for a Tonsillectomy (CPT 42820 / 42821 / 42825 / 42826) runs from about $1,032 in Indianapolis, IN to $14,111 in Virginia Beach, VA, read from hospitals' own price-transparency files. 7 of those metros have at least one hospital publishing a self-pay cash price. This page explains what the billing code covers, what the quoted price does and does not include, and what actually drives the spread between hospitals. These are price references from public data — not a quote, a bill, or medical or financial advice.
These figures are aggregated from hospitals' public price-transparency files — not a quote, a bill, an insurance benefit determination, or medical advice. Your actual out-of-pocket cost depends on your insurance plan (deductible, copay, coinsurance, network), the exact service and any complications, and which hospital you use. Always confirm price and coverage with the hospital and your insurer before care.
What a Tonsillectomy price actually covers
A tonsillectomy removes the tonsils, sometimes together with the adenoids. Coding distinguishes patients under twelve from those twelve and over, and distinguishes tonsillectomy alone from a combined tonsillectomy and adenoidectomy.
Code scope. Coded by age AND whether adenoids are removed. 42820 = tonsillectomy + adenoidectomy (T&A) under age 12 (highest volume); 42821 = T&A age 12+; 42825 = tonsillectomy-only under 12; 42826 = tonsillectomy-only age 12+. All four included so any hospital's age/adenoid tagging matches.
What is — and isn't — in the price
The facility fee covers the operating room and recovery; surgeon and anaesthesia bill separately. Because most patients are children and general anaesthesia is standard, the anaesthesia component is a consistent additional charge rather than an occasional one.
Why Tonsillectomy prices differ so much between hospitals
Age band and whether adenoids are removed in the same operation both change the code, so a hospital's list may show several tonsillectomy lines at different prices. Setting matters as usual, though paediatric cases are more often kept in hospital outpatient departments than moved to ambulatory centres.
What else usually lands on the bill
Adenoidectomy performed in the same operation changes the code. A sleep study, where the operation is for sleep-disordered breathing, is a separate prior charge. Post-operative medication is a pharmacy cost.
What to ask before you book
Confirm which code applies given the patient's age and whether adenoidectomy is planned in the same operation, then ask for the anaesthesia estimate separately.
Where the money actually moves
Ambulatory surgery centres are usually cheaper than hospital departments for straightforward paediatric cases. Confirm which code applies for the child's age and whether adenoidectomy is planned, since both change the price.
What the Tonsillectomy numbers show nationally
A Tonsillectomy costs 13.7× as much in Virginia Beach as in Indianapolis
Across the 31 metros priced here, the typical negotiated rate runs from $1,032 in Indianapolis, IN to $14,111 in Virginia Beach, VA — the same billing codes, the same procedure, 1268% apart.
The individual hospitals reporting the lowest and highest Tonsillectomy prices
Lowest: HARPER UNIVERSITY HOSPITAL (Detroit, MI) at $11; ARROWHEAD REGIONAL MEDICAL CENTER (Riverside, CA) at $186; SOUTHWEST GENERAL HEALTH CENTER (Cleveland, OH) at $228. Highest: CEDARS-SINAI MEDICAL CENTER (Los Angeles, CA) at $25,517; NICKLAUS CHILDREN'S HOSPITAL (Miami, FL) at $21,013; BAYLOR SCOTT & WHITE MEDICAL CENTER GRAPEVINE (Dallas, TX) at $14,713. These are the figures each hospital published in its own file, not an assessment of the care.
7 of 31 metros have a hospital publishing a self-pay Tonsillectomy price
Cheapest published cash price: $382 (Detroit). A cash price is what the hospital will accept from someone paying directly; it is not required and many never publish one.
Insurers pay about 69% below the list price for a Tonsillectomy
Across the 4 metros publishing both, the chargemaster list price is typically 69% above what insurers negotiate. The widest gap is in Cincinnati: $22,260 list against $3,287 negotiated.
How many hospitals actually publish a Tonsillectomy price
187 hospital price-file entries across 31 metros feed this page. A hospital appears only where its own file lists a rate for CPT 42820 / 42821 / 42825 / 42826 — where it does not, it is absent from the table rather than filled in with a guess.
Tonsillectomy price by metro
The typical insurer-negotiated price for a Tonsillectomy, by metro — lowest first. 7 of these 31 metros have at least one hospital publishing a self-pay cash price; 5 publish a chargemaster list price. Open a metro for its full hospital-by-hospital breakdown and who those hospitals are.
| Metro | Typical negotiated | Range | Cash | Hospitals |
|---|---|---|---|---|
| Indianapolis, IN | $1,032 | $1,032–$3,122 | — | 3 |
| Detroit, MI | $1,045 | $11–$5,872 | $382 | 6 |
| Phoenix, AZ | $2,410 | $1,984–$4,098 | — | 8 |
| Cincinnati, OH | $3,287 | $3,231–$5,769 | $13,356 | 5 |
| Nashville, TN | $3,824 | $2,314–$3,981 | — | 9 |
| Houston, TX | $3,895 | $3,726–$4,052 | — | 6 |
| Birmingham, AL | $4,212 | $2,783–$4,424 | — | 4 |
| San Diego, CA | $4,264 | $1,086–$9,420 | — | 3 |
| Cleveland, OH | $4,369 | $228–$4,369 | — | 9 |
| St. Louis, MO | $4,452 | $3,258–$5,814 | $5,985 | 4 |
| Milwaukee, WI | $4,536 | $990–$8,295 | — | 9 |
| Austin, TX | $5,014 | $2,689–$10,200 | — | 9 |
| Washington, DC | $5,051 | $4,926–$6,587 | — | 5 |
| Tampa, FL | $5,063 | $3,670–$5,286 | — | 5 |
| Atlanta, GA | $5,111 | $1,816–$6,863 | — | 7 |
| Philadelphia, PA | $5,227 | $1,940–$11,006 | $8,911 | 10 |
| Dallas, TX | $5,533 | $263–$14,713 | — | 10 |
| Kansas City, MO | $5,814 | $627–$9,248 | — | 7 |
| Sacramento, CA | $5,815 | $5,815 | $10,357 | 3 |
| San Francisco, CA | $5,815 | $5,815 | $10,357 | 6 |
| San Jose, CA | $5,815 | $1,966–$7,541 | — | 3 |
| New York, NY | $6,156 | $3,912–$7,037 | $9,188 | 7 |
| Riverside, CA | $6,290 | $186–$7,189 | — | 4 |
| Denver, CO | $6,681 | $276–$6,719 | — | 10 |
| Hartford, CT | $7,680 | $7,072–$7,680 | — | 3 |
| Seattle, WA | $8,434 | $326–$9,979 | — | 7 |
| Miami, FL | $8,743 | $6,081–$21,013 | — | 4 |
| Los Angeles, CA | $8,944 | $7,189–$25,517 | — | 5 |
| Chicago, IL | $8,980 | $8,980 | — | 3 |
| Portland, OR | $10,122 | $5,518–$10,122 | — | 6 |
| Virginia Beach, VA | $14,111 | $6,448–$14,111 | — | 6 |
Source: hospitals' own machine-readable Standard Charges files, published under the U.S. Hospital Price Transparency rule (45 CFR §180.50). Most recent hospital file in this dataset: July 2026. Prices are references, not quotes or bills, and never medical or financial advice — where a hospital reports no price, nothing is shown rather than a guess.
Frequently asked questions
- How much does a Tonsillectomy cost?
- Across 31 U.S. metros the typical insurer-negotiated price is about $5,227, ranging from $1,032 in Indianapolis to $14,111 in Virginia Beach. Every figure is read from a named hospital's own price-transparency file for CPT 42820 / 42821 / 42825 / 42826.
- Does the price include the doctor's fee?
- The facility fee covers the operating room and recovery; surgeon and anaesthesia bill separately. Because most patients are children and general anaesthesia is standard, the anaesthesia component is a consistent additional charge rather than an occasional one.
- Why do Tonsillectomy prices differ so much between hospitals?
- Age band and whether adenoids are removed in the same operation both change the code, so a hospital's list may show several tonsillectomy lines at different prices. Setting matters as usual, though paediatric cases are more often kept in hospital outpatient departments than moved to ambulatory centres.