Average Medicaid Tonsillectomy Payments in Princeton, WV: $427.59
Avg. Paid
$427.59
Range
$212.38 – $1,385
Total Claims
243
Providers
4
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 Princeton, WV
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Princeton Community Hospital Assn., Inc.
122 12Th Street Ext |
$1,348 | 17 | 13 |
|
Mark Anthony Weitzel
122 12Th St Ste A |
$635.16 | 17 | 15 |
|
Mark Lentner
122 12Th St Ste A |
$1,385 | 22 | 14 |
|
Princeton Community Hospital Assn Inc.
118 12Th Street |
$212.38 | 187 | 170 |
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 Princeton, WV?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Princeton, WV is $427.59 per claim, based on 243 claims from 4 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 Princeton, WV?
There are 4 Medicaid providers offering Tonsillectomy related services in Princeton, WV according to public payment data.
What is the price range for Tonsillectomy in Princeton, WV?
Medicaid reimbursement for Tonsillectomy in Princeton, WV ranges from $212.38 to $1,385 per claim, with an average of $427.59. 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
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Cincinnati, OH
Avg $805.15
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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 Princeton, WV
Office Visit
Avg $44.35
619,780 claims
Blood Work & Lab Tests
Avg $9.28
351,079 claims
Substance Abuse Treatment
Avg $113.71
163,491 claims
Emergency Room Visit
Avg $122.81
156,749 claims
X-Ray
Avg $14.10
127,278 claims
Durable Medical Equipment (DME)
Avg $37.88
113,506 claims
Case Management Services
Avg $81.76
110,969 claims
Urinalysis & Urine Tests
Avg $8.42
100,738 claims