Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Removal of Tonsils and adenoid glands patient younger than age 12 appears on both lists, and there is a standard service package available for it.
Tonsillectomy is the surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat. The procedure is usually performed for sleep-disordered breathing but may still be a treatment when tonsillitis occurs frequently or doesn’t respond to other treatments.
Use of this service is restricted to patients younger than 12. For adolescents and adults, another service package should be used. Your service utilization may vary from this service package for a number of reasons, including your unique clinical profile and where you recieve your services.
This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in the below care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 60%
- Free standing ASC: 40%