Cost of a Tonsillectomy Visit
in Iowa
Reviewed by Momentary Medical Group West PC
Iowa's healthcare system serves patients across 99 counties with a network that balances urban medical centers in Des Moines and Cedar Rapids with critical access hospitals in rural communities. Tonsillectomy patients typically pay between $95 and $705, with a median out-of-pocket cost of $640 based on negotiated insurance rates from 270 active providers. Patients can browse all qualified tonsillectomy providers throughout Iowa to find the best combination of expertise and affordability.
Average
$480
Median
$640
Lowest
$95
Highest
$705
Providers
270
14% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Iowa?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $95 | $2,935 | $4,753 | 309 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $91 | $2,938 | $3,950 | 320 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $85 | $1,186 | $1,313 | 296 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $452 | $1,174 | $1,680 | 311 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $90 | $1,428 | $3,082 | 337 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $85 | $1,304 | $2,810 | 369 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,912 | $3,576 | 341 |
| Septoplasty Nasal septum repair | 30520 | $549 | $1,426 | $1,627 | 255 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $457 | $1,131 | $2,449 | 317 |
| Mastectomy Partial or simple mastectomy | 19301 | $85 | $1,392 | $3,021 | 333 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $361 | $933 | $1,068 | 260 |
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 Iowa
These hospitals in Iowa are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
ORANGE CITY, IA
BELMOND, IA
CLARION, IA
MARENGO, IA
ALGONA, IA
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 Iowa
Iowa's healthcare costs run approximately 9% below the national average, reflecting the state's lower cost of living and competitive insurance market. The state's dispersed population across rural communities and concentration of specialists in urban areas creates distinct pricing patterns for surgical procedures like tonsillectomy.
Urban vs. Rural Provider Availability
Des Moines, Cedar Rapids, and Iowa City concentrate most of Iowa's ENT specialists, creating higher competition and potentially lower prices in these metropolitan areas. Rural Iowa residents often travel to regional centers for tonsillectomy procedures, with some critical access hospitals referring complex cases to larger facilities. The University of Iowa Hospitals and Clinics serves as the state's primary referral center for pediatric ENT cases from across the rural Midwest.
Facility Type and Overhead Costs
Hospital-based outpatient surgery centers affiliated with UnityPoint Health and MercyOne Health Network typically have higher facility fees than independent ambulatory surgery centers. Iowa's certificate-of-need regulations limit the number of surgical facilities, reducing competition but ensuring quality standards. Academic medical centers like the University of Iowa may charge teaching hospital premiums but offer access to the latest surgical techniques.
Insurance Market Competition in Iowa
Wellmark Blue Cross Blue Shield maintains the largest market share in Iowa, followed by UnitedHealthcare and Aetna, creating moderate competition that helps control premium growth. The state's insurance market lacks some national carriers, limiting negotiating leverage for providers but maintaining stable coverage options. Iowa's smaller insurance market means most major health systems have contracts with all primary insurers, reducing network adequacy issues.
Physician Supply and Demand in Iowa
With 270 active ENT providers statewide, Iowa maintains adequate specialist coverage relative to its population, though geographic distribution favors urban areas. The state's medical school and residency programs help maintain physician supply, though rural recruitment remains challenging for surgical specialties. Adequate provider supply in metropolitan areas creates competitive pricing, while rural areas may have limited options but often feature lower overhead costs.
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 Iowa
What is the average cost of a Tonsillectomy visit in Iowa without insurance?
Does Iowa Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Iowa?
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 Iowa?
How does telemedicine affect the cost of seeing a Tonsillectomy in Iowa?
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 |