Average Medicaid Tonsillectomy Payments in Miami, FL: $841.61
Avg. Paid
$841.61
Range
$160.82 – $1,017
Total Claims
6,877
Providers
9
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 Miami, FL
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Miami Children'S Hospital Ambulatory Surgery Center, Llc
800 Sw 108Th Ave |
$1,017 | 5,041 | 4,911 |
|
Sandeep P Dave
3100 Sw 62Nd Ave |
$326.29 | 850 | 785 |
|
Brian Ho
3100 Sw 62Nd Ave |
$364.79 | 307 | 281 |
|
Leonardo Antonio Torres
900 Nw 17Th St |
$529.07 | 209 | 205 |
|
Yamilet Tirado
3100 S.W. 62Nd Avenue |
$160.82 | 202 | 163 |
|
Ramzi Younis
1666 Nw 10 Ave |
$559.72 | 193 | 187 |
|
Octavio De Jesus Carreno
3100 Sw 62Nd Ave |
$239.77 | 35 | 34 |
|
Andres Felipe Orjuela
3100 Sw 62Nd Ave |
$211.31 | 24 | 24 |
|
Mikhaylo B Szczupak
3100 Sw 62Nd Ave |
$313.69 | 16 | 15 |
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 Miami, FL?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Miami, FL is $841.61 per claim, based on 6,877 claims from 9 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 Miami, FL?
There are 9 Medicaid providers offering Tonsillectomy related services in Miami, FL according to public payment data.
What is the price range for Tonsillectomy in Miami, FL?
Medicaid reimbursement for Tonsillectomy in Miami, FL ranges from $160.82 to $1,017 per claim, with an average of $841.61. 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 Miami, FL
Home Health Visit
Avg $43.52
13,238,394 claims
Personal Care Services
Avg $33.56
10,537,763 claims
Non-Emergency Medical Transportation
Avg $17.85
8,361,700 claims
Behavioral & Mental Health Therapy
Avg $96.96
6,731,703 claims
Blood Work & Lab Tests
Avg $1.65
5,777,945 claims
Office Visit
Avg $49.15
4,998,845 claims
Case Management Services
Avg $82.94
3,929,993 claims
Physical Therapy
Avg $41.78
3,470,277 claims