Average Medicaid Tonsillectomy Payments in Nashville, TN: $1,316
Avg. Paid
$1,316
Range
$206.97 – $3,251
Total Claims
11,572
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 Nashville, TN
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Amy S. Whigham
3601 Tvc |
$1,344 | 3,257 | 3,001 |
|
Jay Werkhaven
3601 Tvc |
$1,590 | 2,585 | 2,386 |
|
Frank Wadsworth Virgin
3601 Tvc |
$1,191 | 2,083 | 1,935 |
|
Lyndy J Wilcox
3601 The Vanderbilt Clinic |
$1,061 | 1,466 | 1,312 |
|
James David Phillips
3601 The Vanderbilt Clinic |
$1,281 | 858 | 785 |
|
Ryan Hale Belcher
2200 Childrens Way Fl 7 |
$1,393 | 728 | 672 |
|
Christopher Wootten
2601 Tvc |
$829.09 | 479 | 451 |
|
Kaitlin July O'Brien
3601 The Vanderbilt Clinic |
$2,589 | 54 | 52 |
|
Jason Sun-Hyung Park
3601 The Vanderbilt Clinic |
$212.34 | 20 | 14 |
|
Melissa Johnson
3601 The Vanderbilt Clinic |
$3,251 | 14 | 13 |
|
Mark Anthony Williams
341 Wallace Rd Ste D |
$226.67 | 14 | 13 |
|
Kate O'Connor
1017 16Th Ave S |
$206.97 | 14 | 13 |
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 Nashville, TN?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Nashville, TN is $1,316 per claim, based on 11,572 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 Nashville, TN?
There are 12 Medicaid providers offering Tonsillectomy related services in Nashville, TN according to public payment data.
What is the price range for Tonsillectomy in Nashville, TN?
Medicaid reimbursement for Tonsillectomy in Nashville, TN ranges from $206.97 to $3,251 per claim, with an average of $1,316. 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
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
Alexandria, LA
Avg $282.37
8,774 claims · 5 providers
Other Procedures in Nashville, TN
Blood Work & Lab Tests
Avg $8.25
7,785,390 claims
Case Management Services
Avg $197.77
5,117,343 claims
Office Visit
Avg $46.51
4,188,840 claims
Emergency Room Visit
Avg $115.01
1,887,270 claims
X-Ray
Avg $6.44
1,428,718 claims
Vaccines & Immunizations
Avg $12.95
1,374,325 claims
Urinalysis & Urine Tests
Avg $2.86
953,202 claims
Psychiatric Evaluation
Avg $58.51
924,083 claims