Average Medicaid Tonsillectomy Payments in Du Bois, PA: $494.12
Avg. Paid
$494.12
Range
$494.12 – $494.12
Total Claims
25
Providers
1
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 Du Bois, PA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Gregory James Roscoe
871 Beaver Dr |
$494.12 | 25 | 25 |
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 Du Bois, PA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Du Bois, PA is $494.12 per claim, based on 25 claims from 1 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 Du Bois, PA?
There are 1 Medicaid providers offering Tonsillectomy related services in Du Bois, PA according to public payment data.
What is the price range for Tonsillectomy in Du Bois, PA?
Medicaid reimbursement for Tonsillectomy in Du Bois, PA ranges from $494.12 to $494.12 per claim, with an average of $494.12. Private insurance and self-pay costs are typically higher than these Medicaid rates.
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Other Procedures in Du Bois, PA
Office Visit
Avg $40.55
127,708 claims
Emergency Room Visit
Avg $88.65
59,529 claims
Home Health Visit
Avg $215.63
47,080 claims
Blood Work & Lab Tests
Avg $14.83
44,534 claims
Speech Therapy
Avg $5.93
33,996 claims
Chiropractic Care
Avg $12.04
29,473 claims
EKG / ECG (Electrocardiogram)
Avg $7.65
28,538 claims
Physical Therapy
Avg $24.12
22,504 claims