Average Medicaid Tonsillectomy Payments in Los Angeles, CA: $537.71
Avg. Paid
$537.71
Range
$104.29 – $4,212
Total Claims
1,842
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 Los Angeles, CA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Victor Manuel Duarte
200 Ucla Medical Plz Ste 550 |
$271.19 | 1,487 | 1,380 |
|
Geoffrey B Trenkle
1700 E Cesar E Chavez Ave Ste 2500 |
$134.33 | 157 | 157 |
|
Thomas Kenwise Chung
8635 W 3Rd St Ste 590W |
$4,212 | 132 | 130 |
|
Jeffrey Koempel
4650 W Sunset Blvd |
$168.62 | 26 | 26 |
|
Jahangir Sharifi
1701 E Cesar E Chavez Ave |
$165.34 | 14 | 14 |
|
White Memorial Medical Center
1720 E Cesar E Chavez Ave |
$104.29 | 14 | 14 |
|
Christina Marie Mcalpin
1127 Wilshire Blvd |
$161.87 | 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 Los Angeles, CA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Los Angeles, CA is $537.71 per claim, based on 1,842 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 Los Angeles, CA?
There are 7 Medicaid providers offering Tonsillectomy related services in Los Angeles, CA according to public payment data.
What is the price range for Tonsillectomy in Los Angeles, CA?
Medicaid reimbursement for Tonsillectomy in Los Angeles, CA ranges from $104.29 to $4,212 per claim, with an average of $537.71. 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 Los Angeles, CA
Office Visit
Avg $24.20
16,948,065 claims
Blood Work & Lab Tests
Avg $4.54
14,406,706 claims
Dental Cleaning & Exam
Avg $49.60
3,990,780 claims
X-Ray
Avg $17.59
3,407,369 claims
Behavioral & Mental Health Therapy
Avg $203.16
3,345,905 claims
Urinalysis & Urine Tests
Avg $2.44
3,302,824 claims
Vaccines & Immunizations
Avg $3.85
3,256,340 claims
Emergency Room Visit
Avg $84.68
3,238,140 claims