Cost of a Tonsillectomy Visit
in South Dakota
Reviewed by Momentary Medical Group West PC
South Dakota's predominantly rural healthcare landscape creates unique cost dynamics for surgical procedures, with 51 active Tonsillectomy providers serving the state's dispersed population. Patients typically pay between $197 and $705 for a Tonsillectomy procedure, with a median cost of $411 based on negotiated insurance rates. The state's limited provider density means costs can vary significantly between Sioux Falls, Rapid City, and smaller communities, making it important to compare all available Tonsillectomy providers in South Dakota.
Average
$438
Median
$411
Lowest
$197
Highest
$705
Providers
51
4% above national average
Compare Similar Procedures
How does tonsillectomy compare to related procedures in South Dakota?
| Procedure | CPT | Low | Median | High | Providers |
|---|---|---|---|---|---|
| Knee Replacement Total knee replacement (arthroplasty) | 27447 | $1,099 | $1,965 | $5,330 | 50 |
| Hip Replacement Total hip replacement (arthroplasty) | 27130 | $90 | $1,769 | $3,012 | 67 |
| Cataract Surgery Cataract extraction with intraocular lens insertion | 66984 | $95 | $778 | $1,313 | 53 |
| Knee Arthroscopy Arthroscopy of the knee with meniscectomy | 29881 | $387 | $776 | $1,811 | 53 |
| Gallbladder Removal (Laparoscopic) Laparoscopic cholecystectomy | 47562 | $80 | $975 | $6,146 | 77 |
| Appendectomy (Laparoscopic) Laparoscopic appendectomy | 44970 | $85 | $877 | $2,418 | 66 |
| Hysterectomy (Laparoscopic) Laparoscopic total hysterectomy | 58571 | $85 | $1,242 | $2,541 | 56 |
| Septoplasty Nasal septum repair | 30520 | $90 | $848 | $1,627 | 54 |
| Inguinal Hernia Repair Inguinal hernia repair | 49505 | $439 | $769 | $2,034 | 50 |
| Mastectomy Partial or simple mastectomy | 19301 | $491 | $940 | $2,423 | 53 |
| Carpal Tunnel Surgery Open carpal tunnel release | 64721 | $296 | $622 | $1,068 | 53 |
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 South Dakota
These hospitals in South Dakota are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.
RAPID CITY, SD
SIOUX FALLS, SD
SIOUX FALLS, SD
DAKOTA DUNES, SD
SIOUX FALLS, SD
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 South Dakota
South Dakota's healthcare costs run approximately 3% above the national average despite the state's rural character, reflecting limited provider competition and higher overhead costs for serving dispersed populations. The state's challenging geography creates significant cost disparities between urban medical centers and critical access hospitals in frontier communities.
Urban vs. Rural Provider Availability
The Sioux Falls and Rapid City metro areas concentrate most of South Dakota's ENT specialists, creating cost advantages through higher surgical volumes and competitive pricing. Rural residents often face additional travel and lodging expenses when accessing specialized surgical care, effectively increasing their total treatment costs. Many frontier counties have no local ENT services, requiring patients to drive 2-3 hours for tonsillectomy procedures.
Facility Type and Overhead Costs
Large health systems like Sanford Health and Avera dominate South Dakota's surgical landscape, with their hospital-based outpatient centers typically charging higher facility fees than independent surgery centers. Critical access hospitals in rural areas often refer complex cases to urban centers, but may perform routine tonsillectomies at premium rates due to lower case volumes. Ambulatory surgery centers in larger cities offer cost-effective alternatives for straightforward procedures.
Insurance Market Competition in South Dakota
The concentration of market share among Wellmark Blue Cross Blue Shield, Sanford Health Plan, and UnitedHealthcare creates limited insurer competition, potentially keeping negotiated rates higher than in more competitive markets. Sanford's dual role as both insurer and provider creates interesting dynamics in rate negotiations across the state. The small individual insurance market offers fewer plan choices, limiting patients' ability to shop for better surgical coverage.
Physician Supply and Demand in South Dakota
With 51 active Tonsillectomy providers serving approximately 900,000 residents, South Dakota maintains adequate specialist coverage despite its rural nature. This provider-to-population ratio suggests reasonable access without significant shortages that might drive up pricing through supply constraints. However, geographic distribution remains uneven, with most specialists concentrated in the eastern part of the state around Sioux Falls.
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 South Dakota
What is the average cost of a Tonsillectomy visit in South Dakota without insurance?
Does South Dakota Medicaid cover Tonsillectomy visits?
How do I find an affordable Tonsillectomy near me in South Dakota?
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 South Dakota?
How does telemedicine affect the cost of seeing a Tonsillectomy in South Dakota?
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 |