Average Medicaid Tonsillectomy Payments in New York, NY: $1,467
Avg. Paid
$1,467
Range
$183.70 – $1,829
Total Claims
3,956
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 New York, NY
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
The New York And Presbyterian Hospital
622 W 168Th St |
$1,829 | 1,014 | 1,009 |
|
Nyu Langone Hospitals
550 1St Ave |
$1,543 | 975 | 973 |
|
Lenox Hill Hospital
100 E 77Th St |
$1,677 | 682 | 682 |
|
The New York And Presbyterian Hospital
525 E 68Th St |
$1,741 | 474 | 474 |
|
Roosevelt Surgery Center, Llc
619 W 54Th St |
$1,022 | 302 | 301 |
|
Minyoung Jang
3959 Broadway # Chony5N |
$337.39 | 150 | 150 |
|
Eli Grunstein
3959 Broadway |
$303.44 | 145 | 145 |
|
Alyssa M Hackett
150 E 58Th St Fl 34 |
$372.70 | 102 | 102 |
|
Christina Jane Yang
240 E 38Th St Fl 14 |
$334.69 | 54 | 54 |
|
Tom David Ben Dov
180 Fort Washington Ave # Hp7 |
$326.13 | 31 | 31 |
|
Jay N Dolitsky
261 5Th Ave Rm 901 |
$220.61 | 14 | 14 |
|
Joseph Haddad
620 Columbus Ave Ste 2 |
$183.70 | 13 | 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 New York, NY?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in New York, NY is $1,467 per claim, based on 3,956 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 New York, NY?
There are 12 Medicaid providers offering Tonsillectomy related services in New York, NY according to public payment data.
What is the price range for Tonsillectomy in New York, NY?
Medicaid reimbursement for Tonsillectomy in New York, NY ranges from $183.70 to $1,829 per claim, with an average of $1,467. 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 New York, NY
Home Health Visit
Avg $167.81
48,743,027 claims
Office Visit
Avg $81.86
23,551,154 claims
Blood Work & Lab Tests
Avg $8.39
10,014,709 claims
Psychiatric Evaluation
Avg $116.70
6,547,727 claims
Physical Therapy
Avg $39.29
5,089,280 claims
Emergency Room Visit
Avg $130.02
3,905,512 claims
Case Management Services
Avg $322.62
3,682,218 claims
Eye Exam
Avg $50.07
3,393,865 claims