Average Medicaid Tonsillectomy Payments in Toledo, OH: $907.11
Avg. Paid
$907.11
Range
$162.36 – $1,013
Total Claims
1,047
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 Toledo, OH
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Nationwide Children'S Hospital Toledo, Llc
2213 Cherry St |
$949.98 | 494 | 304 |
|
The Toledo Hospital
2142 N Cove Blvd |
$1,013 | 413 | 358 |
|
Surgery Center At Regency Park, Llc
2000 Regency Ct Ste 101 |
$707.06 | 72 | 71 |
|
Promedica Central Corporation Of Michigan
100 Madison Ave |
$164.80 | 29 | 29 |
|
Afser Shariff
4640 W Alexis Rd |
$162.36 | 26 | 25 |
|
Vincent S Toma
4640 W Alexis Rd |
$172.70 | 13 | 13 |
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 Toledo, OH?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in Toledo, OH is $907.11 per claim, based on 1,047 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 Toledo, OH?
There are 6 Medicaid providers offering Tonsillectomy related services in Toledo, OH according to public payment data.
What is the price range for Tonsillectomy in Toledo, OH?
Medicaid reimbursement for Tonsillectomy in Toledo, OH ranges from $162.36 to $1,013 per claim, with an average of $907.11. 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 $144.73
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Cincinnati, OH
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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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