Average Medicaid Tonsillectomy Payments in Milwaukee, WI: $677.43
Avg. Paid
$677.43
Range
$173.01 – $738.65
Total Claims
5,961
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 Milwaukee, WI
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Children'S Hospital Of Wisconsin, Inc.
9000 W Wisconsin Ave |
$738.65 | 5,107 | 4,879 |
|
Surgicenter Of Greater Milwaukee, Llc
3223 S 103Rd St |
$480.07 | 323 | 296 |
|
Thomas Charles Robey
9000 W Wisconsin Ave |
$210.31 | 184 | 172 |
|
Michael Gorelik
9000 W Wisconsin Ave |
$206.95 | 110 | 103 |
|
Robert H. Chun
9000 W Wisconsin Ave |
$226.51 | 64 | 57 |
|
Valerie A. Flanary
9000 W Wisconsin Ave |
$203.63 | 52 | 51 |
|
Timothy John Martin
9000 W Wisconsin Ave |
$191.13 | 36 | 36 |
|
Sophie Grace Shay
9000 W Wisconsin Ave |
$241.96 | 32 | 25 |
|
Cecille G Sulman
9000 W Wisconsin Ave |
$184.84 | 26 | 26 |
|
Michael Edward Mccormick
9000 W Wisconsin Ave |
$173.01 | 15 | 13 |
|
Luke A Jakubowski
3011 S 56Th St |
$187.95 | 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 Milwaukee, WI?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Milwaukee, WI is $677.43 per claim, based on 5,961 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 Milwaukee, WI?
There are 11 Medicaid providers offering Tonsillectomy related services in Milwaukee, WI according to public payment data.
What is the price range for Tonsillectomy in Milwaukee, WI?
Medicaid reimbursement for Tonsillectomy in Milwaukee, WI ranges from $173.01 to $738.65 per claim, with an average of $677.43. 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 Milwaukee, WI
Blood Work & Lab Tests
Avg $12.08
6,063,751 claims
Office Visit
Avg $50.47
5,280,772 claims
Emergency Room Visit
Avg $64.11
3,433,334 claims
Behavioral & Mental Health Therapy
Avg $97.09
2,167,359 claims
Case Management Services
Avg $88.79
1,899,271 claims
X-Ray
Avg $5.82
1,618,246 claims
Physical Therapy
Avg $31.00
1,562,867 claims
Urinalysis & Urine Tests
Avg $7.57
1,368,239 claims