Average Medicaid Tonsillectomy Payments in Austin, TX: $372.22
Avg. Paid
$372.22
Range
$234.75 – $715.07
Total Claims
717
Providers
7
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 Austin, TX
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
James Johnathan Attra
3705 Medical Pkwy |
$240.18 | 215 | 207 |
|
Danielle Patrice Yarbrough
3705 Medical Pkwy Ste 200 |
$234.75 | 205 | 197 |
|
Strictly Pediatrics Surgery Center Of Central Texas, Llc
1301 Barbara Jordan Blvd. |
$715.07 | 179 | 170 |
|
Joel William Jones
9835 N Lake Creek Pkwy |
$301.63 | 57 | 47 |
|
Stacey Leigh Clark
3705 Medical Pkwy |
$422.17 | 36 | 36 |
|
John H Nowlin
3705 Medical Pkwy |
$256.81 | 13 | 13 |
|
Corrie Elizabeth Roehm
3705 Medical Pkwy |
$282.74 | 12 | 12 |
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 Austin, TX?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Austin, TX is $372.22 per claim, based on 717 claims from 7 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 Austin, TX?
There are 7 Medicaid providers offering Tonsillectomy related services in Austin, TX according to public payment data.
What is the price range for Tonsillectomy in Austin, TX?
Medicaid reimbursement for Tonsillectomy in Austin, TX ranges from $234.75 to $715.07 per claim, with an average of $372.22. 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
Other Procedures in Austin, TX
Blood Work & Lab Tests
Avg $7.09
4,048,248 claims
Personal Care Services
Avg $51.29
3,439,018 claims
Office Visit
Avg $39.88
1,367,991 claims
X-Ray
Avg $5.51
1,081,382 claims
Vaccines & Immunizations
Avg $3.40
861,990 claims
Dental Cleaning & Exam
Avg $37.36
759,881 claims
Emergency Room Visit
Avg $125.71
658,275 claims
Urinalysis & Urine Tests
Avg $2.52
612,948 claims