Average Medicaid Tonsillectomy Payments in Houston, TX: $1,120
Avg. Paid
$1,120
Range
$167.34 – $1,930
Total Claims
7,579
Providers
29
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 Houston, TX
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Scott A. Schraff
6621 Fannin St Fl 5 |
$331.88 | 1,242 | 1,223 |
|
Henri Toufic Traboulsi
6701 Fannin St |
$1,204 | 640 | 620 |
|
Mary Elizabeth Williamson
6701 Fannin St |
$1,278 | 543 | 528 |
|
Shiva Daram
6400 Fannin St Ste 2700 |
$1,081 | 516 | 507 |
|
Tiffany Powell Raynor
6550 Fannin Street |
$1,294 | 503 | 494 |
|
Zi Yang Jiang
6431 Fannin St |
$1,412 | 444 | 437 |
|
Jennifer Yan
6701 Fannin St |
$1,054 | 440 | 433 |
|
Deepak K Mehta
6701 Fannin St Fl 5 |
$1,325 | 421 | 417 |
|
Matthew Seth Sitton
6701 Fannin St Ste 540 |
$1,370 | 385 | 381 |
|
Anna Hopeman Messner
6651 Main St |
$1,238 | 323 | 319 |
|
Amy Li Dimachkieh
6701 Fannin St |
$1,290 | 274 | 272 |
|
James Thomas Albright
6550 Fannin St |
$1,361 | 245 | 240 |
|
Ronald Jason Vilela
6701 Fannin St Ste 640 |
$1,129 | 233 | 230 |
|
Elton Melville Lambert
6701 Fannin St |
$1,630 | 212 | 211 |
|
Zhen Huang
6400 Fannin St Ste 2700 |
$1,033 | 202 | 201 |
|
Alfredo Jimenez
18100 St. John Drive |
$1,930 | 192 | 181 |
|
Joshua Robert Bedwell
6701 Fannin St |
$1,406 | 184 | 173 |
|
Zaid Jawad M B Abu Rajab Altamimi
6701 Fannin St Ste 640.00 |
$1,509 | 107 | 105 |
|
Yi-Chun Carol Liu
6701 Fannin St |
$1,299 | 103 | 102 |
|
Daniel Charles Chelius
2500 Tanglewilde St |
$1,277 | 83 | 82 |
|
Farrukh Rasool Virani
6701 Fannin St |
$1,125 | 67 | 62 |
|
Karina Toa Canadas
2123 Judiway St |
$1,058 | 54 | 53 |
|
Tara L Rosenberg
6701 Fannin St |
$1,859 | 51 | 51 |
|
Joseph Lindsay Edmonds
6621 Fannin St |
$1,557 | 28 | 28 |
|
Maryfrances Musso
6701 Fannin St |
$341.64 | 24 | 24 |
|
Gabriel Gomez
6621 Fannin St |
$195.22 | 24 | 24 |
|
Vivek Mathew John
6431 Fannin St |
$167.34 | 14 | 12 |
|
Susan Omwanghe Edionwe
7707 Fannin St |
$287.59 | 13 | 13 |
|
Kevin D Pereira
6410 Fannin St |
$236.63 | 12 | 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 Houston, TX?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Houston, TX is $1,120 per claim, based on 7,579 claims from 29 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 Houston, TX?
There are 29 Medicaid providers offering Tonsillectomy related services in Houston, TX according to public payment data.
What is the price range for Tonsillectomy in Houston, TX?
Medicaid reimbursement for Tonsillectomy in Houston, TX ranges from $167.34 to $1,930 per claim, with an average of $1,120. 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 Houston, TX
Office Visit
Avg $48.27
8,766,644 claims
Vaccines & Immunizations
Avg $6.36
4,720,768 claims
Dental Cleaning & Exam
Avg $39.95
3,744,881 claims
Blood Work & Lab Tests
Avg $9.56
3,408,214 claims
Emergency Room Visit
Avg $183.70
2,360,699 claims
X-Ray
Avg $9.02
1,931,677 claims
Personal Care Services
Avg $67.63
1,546,221 claims
Urinalysis & Urine Tests
Avg $5.15
1,340,067 claims