Average Medicaid Tonsillectomy Payments in Columbia, SC: $131.50
Avg. Paid
$131.50
Range
$0.00 – $399.04
Total Claims
3,266
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 Columbia, SC
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
William C Giles
9 Richland Medical Park Dr |
$200.17 | 25 | 25 |
|
Ira David Uretzky
145 Park Central Dr Ste 100 |
$208.96 | 70 | 70 |
|
Medical University Hospital Authority
120 Gateway Corporate Blvd |
$137.88 | 83 | 83 |
|
Fred T Garner
200 Arbor Lake Dr Ste 120 |
$188.45 | 113 | 107 |
|
Palmetto Surgery Center Llc
109 Blarney Dr |
$399.04 | 598 | 581 |
|
Prisma Health-Midlands
3301 Harden Street |
$0.00 | 1,103 | 1,064 |
|
Prisma Health-Midlands
5 Richland Medical Park Dr |
$108.69 | 1,274 | 1,269 |
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 Columbia, SC?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Columbia, SC is $131.50 per claim, based on 3,266 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 Columbia, SC?
There are 7 Medicaid providers offering Tonsillectomy related services in Columbia, SC according to public payment data.
What is the price range for Tonsillectomy in Columbia, SC?
Medicaid reimbursement for Tonsillectomy in Columbia, SC ranges from $0.00 to $399.04 per claim, with an average of $131.50. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Tonsillectomy in Other Cities
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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
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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 Columbia, SC
Office Visit
Avg $72.57
2,249,167 claims
Blood Work & Lab Tests
Avg $34.82
1,311,438 claims
Emergency Room Visit
Avg $72.77
1,188,627 claims
Case Management Services
Avg $52.18
1,047,210 claims
Behavioral & Mental Health Therapy
Avg $63.05
790,433 claims
Dental Cleaning & Exam
Avg $34.66
777,605 claims
Psychiatric Evaluation
Avg $122.40
643,281 claims
Home Health Visit
Avg $65.66
600,597 claims