Average Medicaid Tonsillectomy Payments in Charlottesville, VA: $2,528
Avg. Paid
$2,528
Range
$225.27 – $2,877
Total Claims
790
Providers
3
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 Charlottesville, VA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Ariana Ghom Greenwell
1204 W Main St |
$225.27 | 44 | 41 |
|
William T Brand
1204 W Main St Fl 6 |
$225.27 | 60 | 57 |
|
Rector & Visitors Of The University Of Virginia
1215 Lee St Pfs |
$2,877 | 686 | 614 |
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 Charlottesville, VA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Charlottesville, VA is $2,528 per claim, based on 790 claims from 3 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 Charlottesville, VA?
There are 3 Medicaid providers offering Tonsillectomy related services in Charlottesville, VA according to public payment data.
What is the price range for Tonsillectomy in Charlottesville, VA?
Medicaid reimbursement for Tonsillectomy in Charlottesville, VA ranges from $225.27 to $2,877 per claim, with an average of $2,528. Private insurance and self-pay costs are typically higher than these Medicaid rates.
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Avg $1,186
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