Average Medicaid Tonsillectomy Payments in Orlando, FL: $1,359
Avg. Paid
$1,359
Range
$135.99 – $1,865
Total Claims
1,371
Providers
8
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 Orlando, FL
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Sergio S Cervantes
13535 Nemours Pkwy |
$994.93 | 379 | 358 |
|
Charles Anthony Hughes
1720 S Orange Ave Ste 200 |
$1,620 | 293 | 291 |
|
Glenn S. Kanamori
1717 S Orange Ave Ste 100 |
$1,342 | 263 | 251 |
|
Rodrigo C Silva
401 N Mills Ave Ste C |
$1,668 | 194 | 193 |
|
James David Moser
1717 S Orange Ave |
$1,865 | 135 | 132 |
|
Cedric V Pritchett
13535 Nemours Pkwy |
$1,374 | 53 | 51 |
|
James R Kosko
1507 S Hiawassee Rd |
$135.99 | 41 | 38 |
|
Joshua A. Gottschall
1507 S Hiawassee Rd |
$349.46 | 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 Orlando, FL?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Orlando, FL is $1,359 per claim, based on 1,371 claims from 8 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 Orlando, FL?
There are 8 Medicaid providers offering Tonsillectomy related services in Orlando, FL according to public payment data.
What is the price range for Tonsillectomy in Orlando, FL?
Medicaid reimbursement for Tonsillectomy in Orlando, FL ranges from $135.99 to $1,865 per claim, with an average of $1,359. 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 Orlando, FL
Office Visit
Avg $66.63
3,037,031 claims
Blood Work & Lab Tests
Avg $3.57
2,472,749 claims
Emergency Room Visit
Avg $85.72
1,940,642 claims
Speech Therapy
Avg $27.46
1,631,944 claims
Behavioral & Mental Health Therapy
Avg $63.00
1,518,843 claims
X-Ray
Avg $4.58
1,245,043 claims
Vaccines & Immunizations
Avg $9.16
1,114,332 claims
Physical Therapy
Avg $45.06
1,046,201 claims