Average Medicaid Tonsillectomy Payments in Lexington, KY: $746.24
Avg. Paid
$746.24
Range
$166.73 – $1,259
Total Claims
7,470
Providers
12
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 Lexington, KY
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Sanford Archer
740 South Limestone |
$210.20 | 13 | 13 |
|
Jessica Leigh Lange
120 N Eagle Creek Dr Ste 102 |
$189.27 | 16 | 16 |
|
Baptist Health Surgery Center Llc
3000 Baptist Health Blvd Ste 110 |
$188.76 | 25 | 12 |
|
William M Parell
2101 Nicholasville Rd |
$203.66 | 27 | 27 |
|
Saint Joseph Health System, Inc
150 N Eagle Creek Dr |
$670.84 | 32 | 30 |
|
Kyle Thomas Fletcher
800 Rose Street C 236 |
$188.10 | 42 | 41 |
|
Medical Heights Surgery Center, Inc.
240 Fountain Ct |
$396.53 | 72 | 68 |
|
Caitlin Fiorillo
740 South Limestone C300 |
$191.11 | 729 | 705 |
|
Kenneth Charles Iverson
740 South Limestone Kentucky Clinic C300 |
$180.13 | 807 | 740 |
|
Lexington Surgery Center Ltd
2115 Harrodsburg Rd |
$1,259 | 905 | 805 |
|
Christopher Haywood Azbell
740 South Limestone Ear Nose & Throat Clinic |
$166.73 | 1,554 | 1,385 |
|
University Of Kentucky
800 Rose St |
$1,175 | 3,248 | 3,040 |
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 Lexington, KY?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Lexington, KY is $746.24 per claim, based on 7,470 claims from 12 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 Lexington, KY?
There are 12 Medicaid providers offering Tonsillectomy related services in Lexington, KY according to public payment data.
What is the price range for Tonsillectomy in Lexington, KY?
Medicaid reimbursement for Tonsillectomy in Lexington, KY ranges from $166.73 to $1,259 per claim, with an average of $746.24. 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
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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
10,761 claims · 6 providers
Columbus, OH
Avg $798.70
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Atlanta, GA
Avg $1,186
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Other Procedures in Lexington, KY
Blood Work & Lab Tests
Avg $14.22
4,452,973 claims
Office Visit
Avg $40.42
4,343,155 claims
Emergency Room Visit
Avg $156.12
2,128,548 claims
X-Ray
Avg $27.62
1,657,833 claims
Psychiatric Evaluation
Avg $54.73
1,162,452 claims
Physical Therapy
Avg $62.23
1,009,326 claims
Substance Abuse Treatment
Avg $82.19
953,868 claims
Dental Cleaning & Exam
Avg $36.91
818,313 claims