Cost of a Tonsillectomy Visit
in Missouri
Reviewed by Momentary Medical Group West PC
Missouri's healthcare market operates roughly 5% below national averages, creating more affordable options for residents needing surgical procedures like tonsillectomies. Patients across the Show-Me State typically pay between $268 and $559 for tonsillectomy procedures, with a median cost of $480 based on negotiated insurance rates. With over 5,200 active providers performing tonsillectomies throughout Missouri, patients can browse all qualified surgeons to find the best combination of cost and quality for their needs.
Average
$436
Median
$480
Lowest
$268
Highest
$559
Providers
5,242
4% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Missouri?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,272 | $1,915 | $2,246 | 5,186 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $1,274 | $1,917 | $2,249 | 5,286 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $502 | $728 | $811 | 5,258 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $507 | $761 | $892 | 5,187 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $623 | $1,127 | $1,300 | 5,243 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $551 | $966 | $1,185 | 5,445 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $822 | $1,163 | $1,375 | 5,264 |
| Septoplasty Nasal septum repair | 30520 | $573 | $821 | $954 | 5,176 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $493 | $892 | $1,027 | 5,182 |
| Mastectomy Partial or simple mastectomy | 19301 | $516 | $824 | $946 | 5,250 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $402 | $614 | $726 | 5,183 |
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 Missouri
These hospitals in Missouri are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
LAMAR, MO
MONETT, MO
AURORA, MO
LEXINGTON, MO
CHILLICOTHE, MO
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 Missouri
Missouri's healthcare costs run approximately 5% below national averages, reflecting the state's lower cost of living and moderate provider competition across urban centers like St. Louis and Kansas City. The state's mix of metropolitan medical hubs and expansive rural counties creates notable price variations for surgical procedures based on geographic location and facility type.
Urban vs. Rural Provider Availability
Major metropolitan areas around St. Louis and Kansas City concentrate most of Missouri's ENT specialists and surgical facilities, while rural counties often require patients to travel significant distances for tonsillectomy procedures. This geographic disparity can create higher total costs for rural residents due to travel and lodging expenses, though the procedures themselves may be priced lower at regional medical centers. Some rural hospitals in Missouri have partnered with urban health systems to provide specialty surgical services locally.
Facility Type and Overhead Costs
Hospital-based outpatient surgical centers in Missouri typically charge higher facility fees than independent ambulatory surgery centers due to increased overhead and staffing requirements. Major health systems like BJC HealthCare and Mercy operate numerous facilities throughout the state, often maintaining consistent pricing structures across their network locations. Free-standing surgical centers frequently offer competitive rates for routine procedures like tonsillectomies since they focus specifically on outpatient operations.
Insurance Market Competition in Missouri
Anthem, UHC, and Cigna dominate Missouri's commercial insurance market, creating moderate competition that helps control negotiated rates with healthcare providers. The state's decision not to expand Medicaid has reduced insurer participation in some markets, particularly affecting rural areas where fewer plan options may limit negotiating power. Regional insurers and employer self-funded plans also play significant roles in Missouri's healthcare marketplace.
Physician Supply and Demand in Missouri
With over 5,200 providers performing tonsillectomy procedures across Missouri, the state maintains adequate specialist availability relative to its population, particularly in metropolitan areas. This healthy provider supply helps moderate pricing through competition, though wait times for non-urgent procedures can vary seasonally. Rural areas of Missouri continue to face ENT specialist shortages, sometimes requiring patients to seek care in larger cities or accept longer scheduling delays.
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 Missouri
What is the average cost of a Tonsillectomy visit in Missouri without insurance?
Does Missouri Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Missouri?
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 Missouri?
How does telemedicine affect the cost of seeing a Tonsillectomy in Missouri?
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 |