Average Medicaid Tonsillectomy Payments in Boston, MA: $1,885
Avg. Paid
$1,885
Range
$193.40 – $2,256
Total Claims
4,828
Providers
11
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 Boston, MA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Children'S Hospital Corporation
300 Longwood Ave |
$2,193 | 3,151 | 3,147 |
|
Massachusetts Eye And Ear Infirmary
243 Charles St |
$1,564 | 1,000 | 999 |
|
Boston Medical Center Corporation
1 Boston Medical Ctr Pl |
$2,256 | 235 | 235 |
|
Jessica Levi
830 Harrison Ave |
$219.38 | 174 | 173 |
|
Eelam Adil
300 Longwood Ave # Lo-367 |
$225.04 | 84 | 84 |
|
Greg Licameli
300 Longwood Ave |
$257.96 | 64 | 64 |
|
Kenneth Whittemore
300 Longwood Ave |
$225.31 | 53 | 53 |
|
Dara Richer Adams
243 Charles St |
$193.40 | 30 | 30 |
|
Donald G. Keamy
243 Charles St |
$231.19 | 13 | 13 |
|
Anne F Hseu
1 Bowdoin Sq |
$225.52 | 12 | 12 |
|
Mark A Vecchiotti
830 Harrison Ave Ste 1400 |
$222.79 | 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 Boston, MA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Boston, MA is $1,885 per claim, based on 4,828 claims from 11 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 Boston, MA?
There are 11 Medicaid providers offering Tonsillectomy related services in Boston, MA according to public payment data.
What is the price range for Tonsillectomy in Boston, MA?
Medicaid reimbursement for Tonsillectomy in Boston, MA ranges from $193.40 to $2,256 per claim, with an average of $1,885. 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 Boston, MA
Office Visit
Avg $84.37
5,683,879 claims
Blood Work & Lab Tests
Avg $10.29
4,390,978 claims
Emergency Room Visit
Avg $120.95
2,297,423 claims
X-Ray
Avg $10.07
2,027,847 claims
Dental Cleaning & Exam
Avg $34.73
1,751,075 claims
EKG / ECG (Electrocardiogram)
Avg $6.21
1,505,496 claims
Psychiatric Evaluation
Avg $73.99
945,332 claims
Vaccines & Immunizations
Avg $10.76
827,098 claims