Average Medicaid Tonsillectomy Payments
Typical Medicaid Tonsillectomy reimbursement across 622 cities
Avg. Medicaid Paid
$976.50
Price Range
$0.00 – $6,198
Total Claims
553.8K
Cities
622
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.
About This Procedure
Surgical removal of the tonsils, commonly performed for recurrent tonsillitis or obstructive sleep apnea in children and adults.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Shelton, CT | $182.81 | $182.81 – $182.81 | 313 | 1 |
| Livingston, NJ | $388.24 | $360.19 – $1,018 | 305 | 2 |
| Danville, VA | $1,848 | $241.97 – $2,025 | 302 | 2 |
| Boynton Beach, FL | $440.21 | $177.53 – $666.99 | 297 | 4 |
| The Woodlands, TX | $512.42 | $354.21 – $1,209 | 297 | 2 |
| Hartford, KY | $1,191 | $1,191 – $1,191 | 294 | 1 |
| Shawnee, OK | $1,855 | $1,855 – $1,855 | 293 | 1 |
| Sherman, TX | $822.65 | $278.91 – $1,429 | 292 | 2 |
| Chambersburg, PA | $618.01 | $228.73 – $791.27 | 284 | 3 |
| Waco, TX | $1,101 | $221.52 – $1,147 | 281 | 3 |
| Fairfax, VA | $876.25 | $538.70 – $930.14 | 276 | 2 |
| Gastonia, NC | $454.55 | $199.93 – $470.22 | 276 | 2 |
| Centennial, CO | $745.28 | $745.28 – $745.28 | 275 | 1 |
| Zanesville, OH | $785.36 | $785.36 – $785.36 | 275 | 1 |
| Scottsboro, AL | $117.17 | $117.17 – $117.17 | 274 | 1 |
| Scarborough, ME | $424.76 | $424.76 – $424.76 | 272 | 1 |
| Jersey City, NJ | $674.64 | $221.26 – $1,034 | 269 | 2 |
| Myrtle Beach, SC | $361.95 | $203.61 – $445.61 | 269 | 2 |
| Savannah, GA | $205.07 | $205.07 – $205.07 | 265 | 1 |
| Flagstaff, AZ | $1,529 | $307.54 – $1,592 | 265 | 2 |
| Chattanooga, TN | $591.10 | $544.26 – $702.62 | 261 | 3 |
| Lugoff, SC | $226.88 | $208.84 – $264.85 | 261 | 4 |
| La Crosse, WI | $658.35 | $654.28 – $740.74 | 255 | 2 |
| Winter Park, FL | $1,205 | $733.47 – $1,233 | 250 | 2 |
| San Angelo, TX | $1,475 | $219.91 – $1,654 | 248 | 3 |
| Blacksburg, VA | $1,796 | $238.93 – $1,882 | 248 | 2 |
| Princeton, WV | $427.59 | $212.38 – $1,385 | 243 | 4 |
| Coeur D Alene, ID | $882.80 | $882.80 – $882.80 | 243 | 1 |
| Lake Charles, LA | $298.07 | $291.08 – $355.57 | 240 | 2 |
| High Point, NC | $454.86 | $216.27 – $469.84 | 237 | 2 |
| West Burlington, IA | $1,378 | $1,378 – $1,378 | 236 | 1 |
| Glendale, AZ | $1,480 | $292.24 – $1,615 | 234 | 3 |
| Laurinburg, NC | $453.37 | $453.37 – $453.37 | 226 | 1 |
| Green Bay, WI | $671.49 | $575.20 – $693.41 | 225 | 3 |
| Rocky Mount, NC | $578.56 | $578.56 – $578.56 | 219 | 1 |
| Ogdensburg, NY | $1,026 | $203.06 – $1,863 | 218 | 2 |
| Muskegon, MI | $2,678 | $2,678 – $2,678 | 216 | 1 |
| Pocatello, ID | $514.61 | $189.31 – $755.92 | 215 | 5 |
| Huntsville, AL | $228.31 | $190.97 – $477.68 | 215 | 2 |
| Nampa, ID | $231.28 | $231.28 – $231.28 | 209 | 1 |
| Baltimore, MD | $211.24 | $186.85 – $250.91 | 208 | 5 |
| Abilene, TX | $227.60 | $222.86 – $241.76 | 195 | 3 |
| Gallatin, TN | $464.69 | $464.69 – $464.69 | 192 | 1 |
| Rexburg, ID | $1,431 | $212.39 – $3,144 | 191 | 3 |
| Bakersfield, CA | $1,605 | $1,605 – $1,605 | 190 | 1 |
| St George, UT | $151.24 | $67.70 – $206.93 | 190 | 2 |
| Tyler, TX | $1,348 | $181.25 – $2,164 | 190 | 6 |
| Lebanon, NH | $250.13 | $209.98 – $312.83 | 187 | 2 |
| Dakota Dunes, SD | $1,067 | $282.43 – $1,415 | 182 | 3 |
| Fayetteville, WV | $804.04 | $804.04 – $804.04 | 180 | 1 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| 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 averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.