Cost of a Tonsillectomy Visit
in Indiana
Reviewed by Momentary Medical Group West PC
Indiana's healthcare market operates approximately 6% below national cost averages, benefiting patients seeking specialized surgical care across the state's diverse urban and rural regions. Tonsillectomy procedures in Indiana typically range from $85 to $649, with most patients paying around $347 based on negotiated insurance rates from transparency data. With 274 active Tonsillectomy providers serving communities from Indianapolis to Fort Wayne, Indiana patients have substantial options for accessing this common ENT surgical procedure.
Average
$360
Median
$347
Lowest
$85
Highest
$649
Providers
274
14% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Indiana?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $90 | $1,720 | $4,087 | 257 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $85 | $1,619 | $3,549 | 291 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $70 | $669 | $1,385 | 294 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $90 | $663 | $1,642 | 260 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $80 | $827 | $1,834 | 351 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $80 | $757 | $1,804 | 411 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,104 | $2,719 | 294 |
| Septoplasty Nasal septum repair | 30520 | $90 | $683 | $1,472 | 250 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $90 | $627 | $1,448 | 250 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $774 | $1,818 | 273 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $291 | $559 | $1,070 | 246 |
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 Indiana
These hospitals in Indiana are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
INDIANAPOLIS, IN
MISHAWAKA, IN
CROWN POINT, IN
BREMEN, IN
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 Indiana
Indiana's healthcare costs run approximately 6% below national averages, reflecting the state's lower cost of living and competitive provider market across both urban centers and rural communities. The state's central location and growing ambulatory surgery center network create favorable conditions for surgical procedure pricing.
Urban vs. Rural Provider Availability
Indianapolis and Fort Wayne concentrate the majority of Indiana's pediatric ENT specialists, while rural counties often require patients to travel 60+ miles for specialized tonsillectomy services. This geographic disparity creates cost differences, with rural patients sometimes finding lower surgical fees but higher total costs due to travel and overnight stays. Northern Indiana communities near Chicago sometimes access Illinois providers, introducing interstate insurance complexity.
Facility Type and Overhead Costs
Indiana University Health, Community Health Network, and other major health systems operate higher-cost hospital outpatient departments, while independent surgery centers offer identical procedures at 25-35% lower facility fees. Pediatric-focused facilities like Riley Hospital for Children command premium pricing but provide specialized pediatric anesthesia and recovery services. Free-standing surgery centers have proliferated across Indiana's suburban markets, creating competitive pressure on traditional hospital pricing.
Insurance Market Competition in Indiana
Anthem dominates Indiana's individual and employer markets, followed by UHC and regional player MDwise, creating moderate insurer competition that keeps negotiated rates reasonable. The state's decision not to expand Medicaid reduces the uninsured population that providers must subsidize, helping maintain lower commercial rates. Indiana's insurance department actively reviews rate increases, providing additional downward pressure on healthcare cost inflation.
Physician Supply and Demand in Indiana
With 274 active tonsillectomy providers serving Indiana's 6.8 million residents, the state maintains adequate ENT specialist access in urban areas while experiencing shortages in rural regions. This supply distribution affects pricing, with Indianapolis-area surgeons often maintaining higher fees due to convenience and reputation, while providers in smaller markets compete more aggressively on price. Wait times for non-urgent tonsillectomies typically range from 2-6 weeks, indicating balanced supply and demand.
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 Indiana
What is the average cost of a Tonsillectomy visit in Indiana without insurance?
Does Indiana Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Indiana?
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 Indiana?
How does telemedicine affect the cost of seeing a Tonsillectomy in Indiana?
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 |