Average Medicaid Tonsillectomy Payments in Cleveland, OH: $1,235
Avg. Paid
$1,235
Range
$159.56 – $1,520
Total Claims
2,389
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 Cleveland, OH
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
The Cleveland Clinic Foundation
9500 Euclid Ave |
$1,326 | 931 | 756 |
|
University Hospitals Cleveland Medical Center
11100 Euclid Ave |
$1,520 | 679 | 553 |
|
The Metrohealth System
2500 Metrohealth Dr |
$1,220 | 400 | 298 |
|
Tekin Baglam
11100 Euclid Ave |
$159.56 | 89 | 69 |
|
Fairview Hospital
18101 Lorain Ave |
$1,295 | 79 | 67 |
|
Todd Otteson
11100 Euclid Ave |
$350.67 | 79 | 78 |
|
Brandon Hopkins
9500 Euclid Ave |
$434.19 | 37 | 27 |
|
Jay Rajendra Shah
11100 Euclid Ave |
$178.80 | 29 | 28 |
|
Swathi Appachi
9500 Euclid Ave |
$164.74 | 28 | 26 |
|
Michael Weber
11100 Euclid Ave |
$187.02 | 24 | 24 |
|
University Hospitals Cleveland Medical Center
11100 Euclid Ave |
$1,482 | 14 | 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 Cleveland, OH?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Cleveland, OH is $1,235 per claim, based on 2,389 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 Cleveland, OH?
There are 11 Medicaid providers offering Tonsillectomy related services in Cleveland, OH according to public payment data.
What is the price range for Tonsillectomy in Cleveland, OH?
Medicaid reimbursement for Tonsillectomy in Cleveland, OH ranges from $159.56 to $1,520 per claim, with an average of $1,235. 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 Cleveland, OH
Blood Work & Lab Tests
Avg $5.86
7,265,730 claims
Office Visit
Avg $41.74
4,839,931 claims
Home Health Visit
Avg $54.94
3,518,961 claims
Emergency Room Visit
Avg $98.94
3,436,346 claims
Behavioral & Mental Health Therapy
Avg $95.38
2,548,278 claims
X-Ray
Avg $8.95
2,124,741 claims
Substance Abuse Treatment
Avg $65.51
1,764,305 claims
Vaccines & Immunizations
Avg $8.45
1,524,000 claims