Average Medicaid Tonsillectomy Payments in Greenville, SC: $108.59
Avg. Paid
$108.59
Range
$58.45 – $219.82
Total Claims
4,856
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 Greenville, SC
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Michael S Beasley
200 Patewood Dr Ste B400 |
$191.09 | 18 | 18 |
|
Travis Daniel Reeves
200 Patewood Dr Ste B400 |
$219.82 | 124 | 118 |
|
Edward Benjamin Penn
200 Patewood Dr Ste B400 |
$209.95 | 137 | 132 |
|
Nathan Scott Alexander
200 Patewood Dr Ste B400 |
$210.47 | 183 | 176 |
|
Gustavo Guimaraes Rangel
200 Patewood Dr Ste B400 |
$209.74 | 224 | 224 |
|
Prisma Health-Upstate
701 Grove Rd |
$58.45 | 1,379 | 1,345 |
|
Prisma Health-Upstate
200 Patewood Dr |
$108.11 | 2,791 | 2,767 |
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 Greenville, SC?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Greenville, SC is $108.59 per claim, based on 4,856 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 Greenville, SC?
There are 7 Medicaid providers offering Tonsillectomy related services in Greenville, SC according to public payment data.
What is the price range for Tonsillectomy in Greenville, SC?
Medicaid reimbursement for Tonsillectomy in Greenville, SC ranges from $58.45 to $219.82 per claim, with an average of $108.59. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Tonsillectomy in Other Cities
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Avg $425.33
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Phoenix, AZ
Avg $1,967
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St Petersburg, FL
Avg $144.73
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Nashville, TN
Avg $1,316
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Cincinnati, OH
Avg $805.15
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Birmingham, AL
Avg $378.75
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Columbus, OH
Avg $798.70
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Atlanta, GA
Avg $1,186
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Other Procedures in Greenville, SC
Office Visit
Avg $63.19
2,475,692 claims
Blood Work & Lab Tests
Avg $35.65
1,555,095 claims
Emergency Room Visit
Avg $67.16
1,080,286 claims
Home Health Visit
Avg $59.64
1,047,244 claims
Speech Therapy
Avg $47.69
743,694 claims
Physical Therapy
Avg $57.38
728,352 claims
X-Ray
Avg $13.48
718,516 claims
Personal Care Services
Avg $25.98
610,919 claims