Average Medicaid Tonsillectomy Payments in Tyler, TX: $1,348
Avg. Paid
$1,348
Range
$181.25 – $2,164
Total Claims
190
Providers
6
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 Tyler, TX
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Christopher A Perro
2210 Three Lakes Pkwy Ste 100 |
$1,212 | 72 | 72 |
|
Andrew J Lehr
1136 E Grande Blvd |
$1,880 | 56 | 56 |
|
Brian Reilly Langford
1136 E Grande Blvd |
$2,164 | 26 | 26 |
|
Monica Jane Hardee
1136 E Grande Blvd |
$221.52 | 12 | 12 |
|
Timothy Dale
1136 E Grande Blvd |
$181.25 | 12 | 12 |
|
Michael Ross Lewis
1136 E Grande Blvd |
$201.38 | 12 | 12 |
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 Tyler, TX?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Tyler, TX is $1,348 per claim, based on 190 claims from 6 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 Tyler, TX?
There are 6 Medicaid providers offering Tonsillectomy related services in Tyler, TX according to public payment data.
What is the price range for Tonsillectomy in Tyler, TX?
Medicaid reimbursement for Tonsillectomy in Tyler, TX ranges from $181.25 to $2,164 per claim, with an average of $1,348. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Tonsillectomy in Other Cities
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Avg $425.33
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Phoenix, AZ
Avg $1,967
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St Petersburg, FL
Avg $144.73
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Nashville, TN
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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Atlanta, GA
Avg $1,186
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Other Procedures in Tyler, TX
Office Visit
Avg $44.43
469,139 claims
Emergency Room Visit
Avg $103.85
379,823 claims
Blood Work & Lab Tests
Avg $5.27
313,965 claims
Dental Cleaning & Exam
Avg $39.99
266,952 claims
X-Ray
Avg $7.49
188,695 claims
Vaccines & Immunizations
Avg $6.68
122,404 claims
Urinalysis & Urine Tests
Avg $2.44
97,259 claims
Ultrasound
Avg $64.23
94,613 claims