Average Medicaid Tonsillectomy Payments in Albany, NY: $1,397
Avg. Paid
$1,397
Range
$228.13 – $1,900
Total Claims
1,241
Providers
5
Typical Payment Range
Typical Medicaid Tonsillectomy payments fall between $206.59 and $1,054 per claim (median: $326.29). The top 10% of payments exceed $1,741.
Based on per-provider averages across all Medicaid claims in this category.
Surgical removal of the tonsils, commonly performed for recurrent tonsillitis or obstructive sleep apnea in children and adults.
Understanding these costs
The amounts shown are Medicaid reimbursement rates — what state Medicaid programs paid providers per claim. Medicaid typically pays well below private insurance rates and out-of-pocket prices. Use this data to compare relative costs between providers, not as a price estimate for privately insured or self-pay patients.
Providers Offering Tonsillectomy in Albany, NY
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Lara Reichert
50 New Scotland Ave Fl 2 |
$277.93 | 14 | 14 |
|
John P. Gavin
50 New Scotland Ave Fl 2 |
$228.13 | 79 | 79 |
|
Everett Road Asc, Llc
123 Everett Rd |
$1,396 | 83 | 83 |
|
Jason Mouzakes
35 Hackett Blvd |
$247.90 | 259 | 259 |
|
Albany Medical Center Hospital
25 Hackett Blvd |
$1,900 | 806 | 804 |
What to Expect: Tonsillectomy
A tonsillectomy takes about 30-45 minutes under general anesthesia. It's usually an outpatient procedure. Recovery takes 10-14 days. Throat pain is the most common complaint and can be managed with pain medication. A soft diet and plenty of fluids are recommended. Watch for signs of bleeding, which can occur up to 2 weeks after surgery.
Cost Components
National average Medicaid payment per billing code. Individual rates vary by provider and state.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 42820 | Tonsillectomy & adenoidectomy <12 | $1,012 | 494,505 | 1,624 |
| 42830 | Adenoidectomy primary <12 | $707.06 | 97,633 | 368 |
| 42821 | Tonsillectomy & adenoidect >12 | $1,047 | 2,603 | 42 |
| 42826 | Tonsillectomy primary >12 | $686.37 | 314 | 9 |
| 42825 | Tonsillectomy primary <12 | $426.12 | 147 | 4 |
| 42831 | Adenoidectomy primary >12 | — | — | — |
| 42835 | Adenoidectomy secondary <12 | — | — | — |
| 42836 | Adenoidectomy secondary >12 | — | — | — |
These are national Medicaid averages for each billing code. Actual amounts vary by state, provider, and complexity.
Frequently Asked Questions
How much does a Tonsillectomy cost in Albany, NY?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Albany, NY is $1,397 per claim, based on 1,241 claims from 5 providers. Typical payments fall between $206.59 and $1,054. Note: Medicaid rates are typically much lower than private insurance or self-pay prices.
How many providers offer Tonsillectomy in Albany, NY?
There are 5 Medicaid providers offering Tonsillectomy related services in Albany, NY according to public payment data.
What is the price range for Tonsillectomy in Albany, NY?
Medicaid reimbursement for Tonsillectomy in Albany, NY ranges from $228.13 to $1,900 per claim, with an average of $1,397. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Tonsillectomy in Other Cities
Knoxville, TN
Avg $425.33
14,943 claims · 6 providers
Phoenix, AZ
Avg $1,967
14,090 claims · 25 providers
St Petersburg, FL
Avg $144.73
13,997 claims · 6 providers
Nashville, TN
Avg $1,316
11,572 claims · 12 providers
Cincinnati, OH
Avg $805.15
10,929 claims · 18 providers
Birmingham, AL
Avg $378.75
10,761 claims · 6 providers
Columbus, OH
Avg $798.70
10,468 claims · 17 providers
Atlanta, GA
Avg $1,186
9,625 claims · 4 providers
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