Average Medicaid Tonsillectomy Payments in Philadelphia, PA: $1,511
Avg. Paid
$1,511
Range
$216.85 – $3,027
Total Claims
3,329
Providers
15
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 Philadelphia, PA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Ken Kazahaya
34Th & Civic Center Blvd |
$2,167 | 12 | 12 |
|
Ryan Borek
3401 Civic Center Blvd |
$1,592 | 30 | 27 |
|
Alanna Windsor
3401 Civic Center Blvd |
$328.54 | 61 | 61 |
|
David Raleigh Lee
3401 Civic Center Blvd |
$1,419 | 67 | 65 |
|
Mark Rizzi
34Th & Civic Center Blvd |
$1,202 | 69 | 66 |
|
Conor Michael Devine
3401 Civic Center Blvd |
$1,647 | 77 | 73 |
|
St. Christopher'S Healthcare, Llc
160 E Erie Ave |
$2,625 | 86 | 85 |
|
Pamela Anne Mudd
3401 Civic Center Blvd |
$216.85 | 159 | 151 |
|
Alyssa R Terk
160 E Erie Ave |
$460.91 | 177 | 176 |
|
Seth Zwillenberg
1920 Chestnut St |
$1,484 | 192 | 188 |
|
Stc Opco Llc
160 E Erie Ave |
$3,027 | 195 | 193 |
|
Kavita Dedhia
3401 Civic Center Blvd |
$1,367 | 300 | 284 |
|
Childrens Hospital Of Philadelphia
34Th And Civic Center Blvd |
$1,961 | 404 | 364 |
|
Pamela Carol Roehm
3509 N Broad St |
$1,450 | 418 | 416 |
|
David Alan Zwillenberg
3601 A Street |
$1,484 | 1,082 | 1,064 |
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 Philadelphia, PA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Philadelphia, PA is $1,511 per claim, based on 3,329 claims from 15 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 Philadelphia, PA?
There are 15 Medicaid providers offering Tonsillectomy related services in Philadelphia, PA according to public payment data.
What is the price range for Tonsillectomy in Philadelphia, PA?
Medicaid reimbursement for Tonsillectomy in Philadelphia, PA ranges from $216.85 to $3,027 per claim, with an average of $1,511. 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 Philadelphia, PA
Office Visit
Avg $47.22
5,853,067 claims
Substance Abuse Treatment
Avg $57.23
5,131,687 claims
Psychiatric Evaluation
Avg $69.22
3,688,209 claims
Emergency Room Visit
Avg $135.52
3,661,931 claims
X-Ray
Avg $9.69
1,822,183 claims
Behavioral & Mental Health Therapy
Avg $119.23
1,618,868 claims
Blood Work & Lab Tests
Avg $6.85
1,492,079 claims
Dental Cleaning & Exam
Avg $29.51
1,399,541 claims