편도절제술 비용은 얼마인가요?
Tonsillectomy is a surgical procedure to remove the tonsils, usually due to recurrent throat infections or obstructive sleep apnea. It is one of the most common surgeries performed on children and adolescents.
보험 미가입
$5,500
보험 가입
$1,000
메디케어
$800
전국 평균
$2,433
By Elena Bellini, MPH, Health Policy & Management · Last reviewed 2026-04-21 ·
Sources: CMS Medicare Provider Utilization and Payment Data 2025 · Methodology · Editorial standards 개요
A tonsillectomy removes the palatine tonsils, most commonly in children with recurrent tonsillitis, chronic tonsillar hypertrophy causing sleep-disordered breathing, or obstructive sleep apnea. Adenoidectomy is frequently performed in the same procedure and is billed with its own code. Surgery takes 20 to 45 minutes under general anesthesia, and the patient is typically discharged the same day unless there are complicating factors such as very young age, severe sleep apnea, or significant comorbidities. Recovery is notably painful, and post-operative care includes hydration, pain management, and a specific diet progression over 10 to 14 days. Bleeding is the most feared complication and can occur up to two weeks postoperatively. Total billed amount usually includes the ENT surgeon, the facility (ASC or hospital outpatient), anesthesia, and any recovery-room care. Commercial insurers often require prior authorization with documentation of qualifying indications.
비용에 영향을 미치는 요소
- Site of service: ambulatory surgery centers typically charge less than hospital outpatient departments for the same tonsillectomy.
- Concurrent adenoidectomy: bundling tonsils and adenoids (T&A) is common and billed together, but separate coding adds cost over tonsillectomy alone.
- Age: children under 3, or patients with significant sleep apnea, often require overnight monitoring, which adds hospital room charges.
- Surgical technique: coblation, electrocautery, and cold-steel techniques can differ slightly in facility equipment charges.
- Anesthesia time: longer anesthesia for complex airway cases or younger children increases the anesthesia line item.
- Post-operative complications: readmission for bleeding or dehydration generates significant additional charges.
절약 방법
- Choose an ambulatory surgery center or pediatric ASC for low-risk outpatient cases — the facility fee is often substantially lower than hospital outpatient.
- Confirm prior authorization and documentation of qualifying indications (sleep study, throat-culture frequency) before scheduling.
- Verify the ENT surgeon, anesthesiologist, and facility are all in-network to avoid surprise balance billing.
- Ask for a bundled Good Faith Estimate covering surgeon, facility, and anesthesia if self-pay.
- Schedule surgery after the family deductible is met (often late in the plan year) to maximize insurance coverage.
- Use HSA or FSA dollars for deductible and coinsurance payments.
보험 및 보장 참고사항
Commercial plans and Medicaid cover tonsillectomy for medically necessary indications — typically documented recurrent tonsillitis by the Paradise criteria, sleep-disordered breathing confirmed by history or sleep study, or tonsil hypertrophy causing functional problems. Prior authorization is commonly required. Medicare rarely covers tonsillectomy because adult cases are uncommon; when it does, Part A or Part B applies depending on setting. Expect to owe your deductible plus coinsurance. Surgeon, facility, and anesthesia are typically billed separately. CHIP and Medicaid programs cover tonsillectomy for eligible children at low or zero cost-sharing.
Data sources for this page
Cost figures on this page are compiled from the following sources, triangulated per the rules in our methodology:
- CMS Medicare Provider Utilization and Payment Data 2025 — primary CMS reference used as the Medicare-rate anchor.
- Hospital Price Transparency machine-readable files (HPT MRFs) from a sample of major hospitals in each state, per the federal Hospital Price Transparency rule.
- Transparency in Coverage payer in-network rate files for commercial-rate cross-validation.
- State All-Payer Claims Database (APCD) summaries where published (Colorado, New Hampshire, Massachusetts, Minnesota, Maine, Utah, Vermont, Rhode Island, Washington, Oregon).
Last reviewed 2026-04-21. See editorial standards for our fact-checking process and correction policy.
Range: $3,950 to $7,600 · 50 states shown
주별 비용
| 주 | 보험 미가입 | 보험 가입 | 메디케어 |
|---|---|---|---|
| Mississippi | $3,950 | $720 | $580 |
| Arkansas | $4,150 | $750 | $600 |
| West Virginia | $4,150 | $750 | $600 |
| Alabama | $4,300 | $780 | $620 |
| Oklahoma | $4,300 | $780 | $620 |
| Kentucky | $4,700 | $850 | $680 |
| Louisiana | $4,750 | $860 | $690 |
| Iowa | $4,850 | $880 | $700 |
| New Mexico | $4,850 | $880 | $700 |
| South Carolina | $4,850 | $880 | $700 |
| South Dakota | $4,850 | $880 | $700 |
| Kansas | $4,900 | $890 | $710 |
| North Dakota | $4,900 | $890 | $710 |
| Idaho | $4,950 | $900 | $720 |
| Nebraska | $4,950 | $900 | $720 |
| Tennessee | $4,950 | $900 | $720 |
| Indiana | $5,100 | $930 | $740 |
| Missouri | $5,100 | $930 | $740 |
| Utah | $5,100 | $930 | $740 |
| Wyoming | $5,100 | $930 | $740 |
| Georgia | $5,150 | $940 | $750 |
| North Carolina | $5,150 | $940 | $750 |
| Michigan | $5,250 | $950 | $760 |
| Montana | $5,250 | $950 | $760 |
| Arizona | $5,400 | $980 | $780 |
| Ohio | $5,400 | $980 | $780 |
| Wisconsin | $5,400 | $980 | $780 |
| Maine | $5,450 | $990 | $790 |
| Texas | $5,450 | $990 | $790 |
| Florida | $5,550 | $1,000 | $810 |
| Minnesota | $5,550 | $1,000 | $810 |
| Illinois | $5,650 | $1,050 | $820 |
| Pennsylvania | $5,650 | $1,050 | $820 |
| Delaware | $5,700 | $1,050 | $830 |
| Nevada | $5,700 | $1,050 | $830 |
| Vermont | $5,700 | $1,050 | $830 |
| Virginia | $5,700 | $1,050 | $830 |
| Colorado | $5,850 | $1,050 | $850 |
| New Hampshire | $5,850 | $1,050 | $850 |
| Oregon | $5,850 | $1,050 | $850 |
| Maryland | $6,050 | $1,100 | $880 |
| Rhode Island | $6,100 | $1,100 | $890 |
| Washington | $6,100 | $1,100 | $890 |
| Connecticut | $6,600 | $1,200 | $960 |
| New Jersey | $6,600 | $1,200 | $960 |
| California | $7,250 | $1,300 | $1,050 |
| Massachusetts | $7,300 | $1,350 | $1,050 |
| Alaska | $7,450 | $1,350 | $1,100 |
| New York | $7,450 | $1,350 | $1,100 |
| Hawaii | $7,600 | $1,400 | $1,100 |
자주 묻는 질문
보험 없이 편도절제술 비용은 얼마인가요?
미국에서 편도절제술의 보험 미가입 평균 비용은 $5,500입니다. 주에 따라 비용이 크게 달라집니다.
보험이 편도절제술을(를) 보장하나요?
대부분의 건강보험은 의학적으로 필요한 경우 편도절제술을(를) 보장합니다. 보험 적용 시 평균 본인부담금은 $1,000입니다.
메디케어가 편도절제술을(를) 보장하나요?
메디케어 파트 B는 일반적으로 의사의 처방이 있을 때 편도절제술을(를) 보장합니다. 메디케어 승인 평균 금액은 $800입니다.
Elena Bellini 검토 · 마지막 검토: 2026-04-21
데이터 출처: CMS Medicare Provider Utilization and Payment Data 2025. 최종 업데이트: 2026-03-01. 이 정보는 교육 목적으로만 제공되며 의료 조언이 아닙니다. 본 웹사이트는 정보 제공 목적으로만 운영되며 의료 조언이 아닙니다. 항상 자격을 갖춘 의료 전문가와 상담하세요.