Average Medicaid Tonsillectomy Payments in Louisville, KY: $967.44
Avg. Paid
$967.44
Range
$165.40 – $1,662
Total Claims
3,462
Providers
13
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 Louisville, KY
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Norton Hospitals, Inc
200 E Chestnut St |
$838.61 | 1,468 | 1,343 |
|
Norton Hospitals Inc
234 E Gray St |
$1,385 | 1,314 | 1,261 |
|
Swapna Kartha Chandran
411 E Chestnut St # Street6 |
$183.31 | 209 | 194 |
|
Premier Surgery Center Of Louisville Lp
2511 Terra Crossing Blvd |
$1,662 | 117 | 98 |
|
Wes A Allison
3515 Poplar Level Road |
$191.02 | 113 | 108 |
|
Jeffrey C Nau
3999 Dutchmans Ln, Suite #3A |
$165.40 | 69 | 66 |
|
Michael J Brown
3999 Dutchmans Ln, Suite #3A |
$169.82 | 44 | 41 |
|
Dary Jonathan Costa
411 E Chestnut St # Level6 |
$209.41 | 30 | 27 |
|
Amy L. Ingram
4004 Dupont Cir |
$193.51 | 29 | 28 |
|
Joseph J Creely
4950 Norton Healthcare Blvd |
$180.20 | 27 | 25 |
|
Vicki Owczarzak
401 E Chestnut St Unit 170 |
$173.02 | 16 | 14 |
|
Steven D Shotts
2944 Breckenridge Ln |
$200.62 | 14 | 14 |
|
Matthew Gregory Yantis
2944 Breckenridge Ln |
$192.15 | 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 Louisville, KY?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Louisville, KY is $967.44 per claim, based on 3,462 claims from 13 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 Louisville, KY?
There are 13 Medicaid providers offering Tonsillectomy related services in Louisville, KY according to public payment data.
What is the price range for Tonsillectomy in Louisville, KY?
Medicaid reimbursement for Tonsillectomy in Louisville, KY ranges from $165.40 to $1,662 per claim, with an average of $967.44. 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 Louisville, KY
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Avg $9.84
7,166,442 claims
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Avg $41.24
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Avg $91.42
3,677,814 claims
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Avg $161.52
2,991,678 claims
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Avg $104.97
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Avg $62.63
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Avg $29.27
1,711,281 claims
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Avg $12.91
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