Cost of a Tonsillectomy Visit
in Ohio
Reviewed by Momentary Medical Group West PC
Ohio's healthcare system serves over 11.8 million residents through a balanced mix of urban medical centers and rural clinics, with costs for surgical procedures running approximately 2% below national averages. Tonsillectomy patients in Ohio typically pay between $85 and $559, with a median cost of $297 based on negotiated insurance rates across 3,518 active providers statewide. Browse all tonsillectomy providers in Ohio to compare costs and find the right surgeon for your needs.
Average
$313
Median
$297
Lowest
$85
Highest
$559
Providers
3,518
25% below national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in Ohio?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $848 | $1,471 | $2,491 | 3,206 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $85 | $1,415 | $2,491 | 3,692 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $335 | $613 | $1,087 | 3,282 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $338 | $585 | $983 | 3,234 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $85 | $667 | $1,185 | 4,653 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $355 | $660 | $1,185 | 4,341 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $917 | $1,597 | 3,541 |
| Septoplasty Nasal septum repair | 30520 | $357 | $592 | $1,116 | 3,245 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $328 | $547 | $1,039 | 3,201 |
| Mastectomy Partial or simple mastectomy | 19301 | $303 | $598 | $1,175 | 3,266 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $268 | $453 | $797 | 3,211 |
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 Ohio
These hospitals in Ohio are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
AKRON, OH
YOUNGSTOWN, OH
Wright-Patterson AFB, OH
MARIETTA, OH
OBERLIN, OH
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 Ohio
Healthcare costs in Ohio run approximately 2% below the national average, reflecting the state's moderate cost of living and competitive insurance market. The Buckeye State's balanced urban-rural population creates diverse pricing structures, with major metropolitan areas supporting premium surgical facilities while smaller communities offer more affordable options.
Urban vs. Rural Provider Availability
Ohio's major cities like Columbus, Cleveland, and Cincinnati concentrate most ENT specialists, creating competitive pricing and shorter wait times for tonsillectomy procedures. Rural counties in southeastern and northwestern Ohio have limited specialist access, often requiring patients to travel to regional medical centers. This geographic disparity can add transportation costs but may offer access to lower-priced facilities outside major metropolitan areas.
Facility Type and Overhead Costs
Hospital-based outpatient surgery departments at Cleveland Clinic, Ohio State Wexner Medical Center, and Cincinnati Children's typically charge premium rates due to higher overhead and academic medical center status. Independent ambulatory surgery centers throughout Ohio often provide the same quality care at 30-50% lower costs. Community hospitals in mid-sized cities like Dayton and Toledo offer competitive pricing between these extremes.
Insurance Market Competition in Ohio
Strong competition among Medical Mutual of Ohio (the state's largest insurer), Anthem, and UnitedHealthcare creates favorable negotiated rates for surgical procedures. Ohio's insurance marketplace offers multiple plan options in most counties, giving consumers leverage to choose cost-effective coverage. The competitive environment has kept premium increases moderate compared to less competitive state markets.
Physician Supply and Demand in Ohio
With 3,518 providers offering tonsillectomy services across Ohio, the state maintains adequate surgical capacity to meet patient demand without significant wait times. This robust provider network includes both adult and pediatric ENT specialists, creating competitive pricing pressure. The concentration of medical schools and residency programs in Ohio ensures steady physician supply, helping control costs compared to underserved regions.
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 Ohio
What is the average cost of a Tonsillectomy visit in Ohio without insurance?
Does Ohio Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in Ohio?
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 Ohio?
How does telemedicine affect the cost of seeing a Tonsillectomy in Ohio?
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 |