Average Medicaid Tonsillectomy Payments in West Bloomfield, MI: $235.50
Avg. Paid
$235.50
Range
$145.28 – $3,016
Total Claims
2,514
Providers
2
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 West Bloomfield, MI
| Provider | Avg. Paid | Claims | Patients |
|---|---|---|---|
|
Henry Ford Health System
6777 W Maple Rd |
$3,016 | 79 | 79 |
|
Michigan Pediatric Ent Associates, Pllc
7001 Orchard Lake Rd |
$145.28 | 2,435 | 2,418 |
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 West Bloomfield, MI?
Based on public Medicaid payment data, the average Medicaid reimbursement for Tonsillectomy in West Bloomfield, MI is $235.50 per claim, based on 2,514 claims from 2 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 West Bloomfield, MI?
There are 2 Medicaid providers offering Tonsillectomy related services in West Bloomfield, MI according to public payment data.
What is the price range for Tonsillectomy in West Bloomfield, MI?
Medicaid reimbursement for Tonsillectomy in West Bloomfield, MI ranges from $145.28 to $3,016 per claim, with an average of $235.50. Private insurance and self-pay costs are typically higher than these Medicaid rates.
Tonsillectomy in Other Cities
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Avg $378.75
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Avg $798.70
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Avg $1,186
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Other Procedures in West Bloomfield, MI
Office Visit
Avg $82.12
448,300 claims
Blood Work & Lab Tests
Avg $2.84
153,452 claims
Urinalysis & Urine Tests
Avg $2.74
98,546 claims
Dental Cleaning & Exam
Avg $35.92
88,736 claims
Emergency Room Visit
Avg $189.76
51,039 claims
X-Ray
Avg $19.48
41,846 claims
Eye Exam
Avg $40.50
29,733 claims
Psychiatric Evaluation
Avg $66.19
28,622 claims