Average Medicaid Tonsillectomy Payments in Fort Wayne, IN: $383.88
Avg. Paid
$383.88
Range
$196.58 – $445.79
Total Claims
1,433
Providers
8
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 Fort Wayne, IN
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Paul William Porter
10021 Dupont Circle Ct |
$196.58 | 13 | 13 |
|
Ent Realty Corp
7900 W Jefferson Blvd |
$284.97 | 53 | 46 |
|
David W Stein
10021 Dupont Circle Ct |
$321.05 | 63 | 53 |
|
Brian D Herr
10021 Dupont Circle Ct |
$445.79 | 77 | 68 |
|
Edward Westfall
10021 Dupont Circle Ct |
$282.18 | 88 | 68 |
|
Sreeya Yalamanchali
10021 Dupont Circle Ct |
$381.25 | 126 | 104 |
|
Adam R Kaiser
10021 Dupont Circle Ct |
$377.91 | 146 | 130 |
|
Deepkaran K Reddy
10021 Dupont Circle Ct |
$403.52 | 867 | 790 |
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 Fort Wayne, IN?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Fort Wayne, IN is $383.88 per claim, based on 1,433 claims from 8 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 Fort Wayne, IN?
There are 8 Medicaid providers offering Tonsillectomy related services in Fort Wayne, IN according to public payment data.
What is the price range for Tonsillectomy in Fort Wayne, IN?
Medicaid reimbursement for Tonsillectomy in Fort Wayne, IN ranges from $196.58 to $445.79 per claim, with an average of $383.88. 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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Avg $1,967
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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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Avg $1,186
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Other Procedures in Fort Wayne, IN
Office Visit
Avg $58.43
2,675,831 claims
Blood Work & Lab Tests
Avg $7.81
1,332,302 claims
Emergency Room Visit
Avg $106.03
1,181,321 claims
Substance Abuse Treatment
Avg $88.84
999,164 claims
Psychiatric Evaluation
Avg $62.23
945,008 claims
Case Management Services
Avg $63.38
852,965 claims
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Avg $8.10
731,731 claims
X-Ray
Avg $20.01
666,060 claims