Average Medicaid Tonsillectomy Payments in Winston Salem, NC: $145.67
Avg. Paid
$145.67
Range
$111.41 – $216.27
Total Claims
940
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 Winston Salem, NC
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Eleanor Pitz Kiell
Medical Center Blvd |
$216.27 | 12 | 12 |
|
Stephen Bradley Potts
110 Charlois Blvd |
$216.27 | 17 | 15 |
|
Daniel Jeffrey Kirse
Medical Center Blvd |
$172.78 | 42 | 36 |
|
Stephen Andrew Harper
110 Charlois Blvd |
$111.41 | 66 | 37 |
|
William Frederick Mcguirt
110 Charlois Blvd |
$144.52 | 803 | 612 |
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 Winston Salem, NC?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Winston Salem, NC is $145.67 per claim, based on 940 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 Winston Salem, NC?
There are 5 Medicaid providers offering Tonsillectomy related services in Winston Salem, NC according to public payment data.
What is the price range for Tonsillectomy in Winston Salem, NC?
Medicaid reimbursement for Tonsillectomy in Winston Salem, NC ranges from $111.41 to $216.27 per claim, with an average of $145.67. 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
10,761 claims · 6 providers
Columbus, OH
Avg $798.70
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Atlanta, GA
Avg $1,186
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Other Procedures in Winston Salem, NC
Office Visit
Avg $56.55
2,112,661 claims
Blood Work & Lab Tests
Avg $9.95
1,100,364 claims
Emergency Room Visit
Avg $152.58
1,052,025 claims
Dental Cleaning & Exam
Avg $30.19
626,976 claims
Speech Therapy
Avg $48.12
581,644 claims
X-Ray
Avg $8.19
523,133 claims
Vaccines & Immunizations
Avg $16.89
496,876 claims
Personal Care Services
Avg $105.36
383,584 claims