Average Medicaid Tonsillectomy Payments in San Antonio, TX: $1,521
Avg. Paid
$1,521
Range
$190.92 – $2,181
Total Claims
5,489
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 San Antonio, TX
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Marisa Anne Earley
8300 Floyd Curl Dr |
$366.98 | 27 | 26 |
|
Roderick Donald Moe
16723 Huebner Rd |
$205.87 | 39 | 38 |
|
Juan Alfredo Bonilla
16723 Huebner Rd |
$200.05 | 86 | 83 |
|
Nadine Haykal
4502 Medical Dr |
$1,419 | 152 | 151 |
|
Wasyl Szeremeta
16723 Huebner Rd |
$1,628 | 163 | 161 |
|
Michael A Demarcantonio
3551 Roger Brooke Dr |
$190.92 | 181 | 167 |
|
Clayton Farahani
333 N Santa Rosa |
$2,181 | 338 | 329 |
|
Morgan Taylor Fordham
333 N. Santa Rosa, Ste Ll |
$1,961 | 436 | 420 |
|
Timothy Patrick Mcevoy
525 Oak Centre Dr Ste 350 |
$538.20 | 465 | 443 |
|
Mark Boston
333 N Santa Rosa St |
$1,300 | 572 | 566 |
|
Jack C Borders
333 N Santa Rosa |
$1,720 | 3,030 | 3,025 |
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 San Antonio, TX?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in San Antonio, TX is $1,521 per claim, based on 5,489 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 San Antonio, TX?
There are 11 Medicaid providers offering Tonsillectomy related services in San Antonio, TX according to public payment data.
What is the price range for Tonsillectomy in San Antonio, TX?
Medicaid reimbursement for Tonsillectomy in San Antonio, TX ranges from $190.92 to $2,181 per claim, with an average of $1,521. 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 San Antonio, TX
Office Visit
Avg $47.25
4,471,070 claims
Personal Care Services
Avg $59.18
4,411,375 claims
Dental Cleaning & Exam
Avg $40.74
2,116,599 claims
Vaccines & Immunizations
Avg $6.82
1,972,578 claims
Emergency Room Visit
Avg $126.61
1,783,972 claims
Home Health Visit
Avg $36.92
1,523,622 claims
Blood Work & Lab Tests
Avg $7.55
1,133,231 claims
Physical Therapy
Avg $40.31
1,006,482 claims