Average Medicaid Tonsillectomy Payments in Cincinnati, OH: $805.15
Avg. Paid
$805.15
Range
$157.77 – $1,138
Total Claims
10,929
Providers
18
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 Cincinnati, OH
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Children'S Hospital Medical Center
3333 Burnet Ave |
$1,138 | 5,908 | 4,919 |
|
Charles M Myer
3333 Burnet Ave |
$471.29 | 931 | 881 |
|
Yann-Fuu Kou
3333 Burnet Ave # 2018 |
$817.87 | 740 | 733 |
|
Robin T Cotton
3333 Burnet Ave |
$510.59 | 632 | 616 |
|
Jay Paul Willging
3333 Burnet Ave |
$282.34 | 580 | 563 |
|
Matthew Michael Smith
3333 Burnet Ave Ml 2018 |
$322.11 | 415 | 405 |
|
John H Greinwald
3333 Burnet Ave |
$290.04 | 374 | 355 |
|
Douglas Clayton Von Allmen
3333 Burnet Ave Ml 2018 |
$235.61 | 312 | 285 |
|
Carol Li
3333 Burnet Ave |
$181.53 | 260 | 246 |
|
Michel Nassar
3333 Burnet Ave |
$328.88 | 200 | 199 |
|
Ashley Lauren Soaper
3333 Burnet Ave |
$157.77 | 183 | 161 |
|
Aimee Adair Kennedy
3333 Burnet Ave # 9016 |
$161.45 | 125 | 113 |
|
Philip Knollman
3333 Burnet Ave |
$367.31 | 106 | 104 |
|
Catherine K Hart
3333 Burnet Avenue |
$193.78 | 61 | 57 |
|
Charles Myer
3333 Burnet Ave |
$201.45 | 43 | 41 |
|
Christine Hungerford Heubi
3333 Burnet Ave |
$187.34 | 29 | 26 |
|
Alessandro De Alarcon
3333 Burnet Ave |
$205.78 | 16 | 16 |
|
Daniel I Choo
3333 Burnet Ave |
$206.55 | 14 | 14 |
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 Cincinnati, OH?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Cincinnati, OH is $805.15 per claim, based on 10,929 claims from 18 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 Cincinnati, OH?
There are 18 Medicaid providers offering Tonsillectomy related services in Cincinnati, OH according to public payment data.
What is the price range for Tonsillectomy in Cincinnati, OH?
Medicaid reimbursement for Tonsillectomy in Cincinnati, OH ranges from $157.77 to $1,138 per claim, with an average of $805.15. 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
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
Alexandria, LA
Avg $282.37
8,774 claims · 5 providers
Other Procedures in Cincinnati, OH
Blood Work & Lab Tests
Avg $7.16
12,933,390 claims
Office Visit
Avg $57.26
6,244,164 claims
Emergency Room Visit
Avg $94.36
2,312,527 claims
Home Health Visit
Avg $67.23
2,297,701 claims
Behavioral & Mental Health Therapy
Avg $87.07
2,275,452 claims
Substance Abuse Treatment
Avg $55.29
2,244,339 claims
Psychiatric Evaluation
Avg $79.56
1,780,978 claims
Urinalysis & Urine Tests
Avg $2.81
1,707,210 claims