Average Medicaid Tonsillectomy Payments in Rock Hill, SC: $386.87
Avg. Paid
$386.87
Range
$161.34 – $432.72
Total Claims
825
Providers
5
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 Rock Hill, SC
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Rock Hill Surgery Center, Llc
198 S Herlong Ave |
$432.72 | 675 | 668 |
|
Chad S Kessler
200 S Herlong Ave |
$189.57 | 51 | 50 |
|
Amisub Of South Carolina, Inc.
222 S Herlong Ave |
$161.34 | 45 | 45 |
|
Mark Jeffrey Abrams
200 S Herlong Ave |
$180.35 | 29 | 28 |
|
Gregory Stokes Parsons
200 S Herlong Ave Ste A |
$196.84 | 25 | 25 |
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 Rock Hill, SC?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Rock Hill, SC is $386.87 per claim, based on 825 claims from 5 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 Rock Hill, SC?
There are 5 Medicaid providers offering Tonsillectomy related services in Rock Hill, SC according to public payment data.
What is the price range for Tonsillectomy in Rock Hill, SC?
Medicaid reimbursement for Tonsillectomy in Rock Hill, SC ranges from $161.34 to $432.72 per claim, with an average of $386.87. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Tonsillectomy in Other Cities
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Avg $1,967
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Avg $144.73
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Avg $1,316
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Cincinnati, OH
Avg $805.15
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Birmingham, AL
Avg $378.75
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Columbus, OH
Avg $798.70
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Avg $1,186
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Other Procedures in Rock Hill, SC
Office Visit
Avg $74.20
545,668 claims
Home Health Visit
Avg $62.67
407,517 claims
Blood Work & Lab Tests
Avg $30.08
273,667 claims
Personal Care Services
Avg $20.37
186,716 claims
Emergency Room Visit
Avg $43.04
185,783 claims
Psychiatric Evaluation
Avg $139.59
171,950 claims
Vaccines & Immunizations
Avg $13.68
150,867 claims
Dental Cleaning & Exam
Avg $32.43
146,991 claims