Average Medicaid Tonsillectomy Payments in Richmond, VA: $1,454
Avg. Paid
$1,454
Range
$191.89 – $2,518
Total Claims
3,059
Providers
11
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 Richmond, VA
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Hca Health Services Of Virginia Inc
1602 Skipwith Rd |
$1,255 | 12 | 12 |
|
Ghedak Nather Ansari
1000 E Broad St |
$271.49 | 12 | 12 |
|
James C Tyson
161 Wadsworth Dr |
$764.93 | 13 | 13 |
|
Jin Sung Lim
161 Wadsworth Drive |
$535.84 | 14 | 13 |
|
Stony Point Surgery Center, L.L.C
8700 Stony Point Pkwy |
$700.63 | 15 | 15 |
|
Virginia Eye Institute Inc
402 Westhampton Sta |
$655.90 | 19 | 19 |
|
Bon Secours St. Mary'S Hospital Of Richmond Llc
5801 Bremo Rd |
$1,134 | 96 | 75 |
|
Rajanya Petersson
1250 E Marshall Street |
$229.59 | 173 | 165 |
|
Kelley Melissa Dodson
1201 E Marshall St |
$191.89 | 375 | 328 |
|
Virginia Ent Surgery Center Inc
6600 W Broad St Ste 210 |
$867.41 | 1,030 | 966 |
|
Virginia Commonwealth University Health System Authority
1250 E Marshall St |
$2,518 | 1,300 | 1,115 |
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 Richmond, VA?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Richmond, VA is $1,454 per claim, based on 3,059 claims from 11 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 Richmond, VA?
There are 11 Medicaid providers offering Tonsillectomy related services in Richmond, VA according to public payment data.
What is the price range for Tonsillectomy in Richmond, VA?
Medicaid reimbursement for Tonsillectomy in Richmond, VA ranges from $191.89 to $2,518 per claim, with an average of $1,454. 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 Richmond, VA
Blood Work & Lab Tests
Avg $4.30
4,017,522 claims
Non-Emergency Medical Transportation
Avg $26.22
2,907,745 claims
Office Visit
Avg $68.82
2,636,996 claims
Substance Abuse Treatment
Avg $53.32
2,490,009 claims
Behavioral & Mental Health Therapy
Avg $179.96
2,168,703 claims
Emergency Room Visit
Avg $137.78
2,065,177 claims
X-Ray
Avg $7.41
1,597,204 claims
Physical Therapy
Avg $84.50
1,259,338 claims