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Draining An Abscess In The Roof Of The Mouth

Ohio rates for HCPCS 42000

Opens and drains a pocket of pus, fluid or blood in the roof of the mouth or in the uvula, the small flap that hangs at the back of the throat. A cut is made through the lining, the collection is emptied and the area is rinsed out. It relieves pain, pressure and swelling that can make swallowing difficult.

Rates data updated July 2026.

How much does Draining An Abscess In The Roof Of The Mouth cost?

$2,599

Typical total for the visit. In Ohio, July 2026.

Insurers have agreed to pay about $2,599 for this procedure. That total is two separate charges: $145 to the doctor who performs it, and $2,455 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$145$107 to $174
Facility feeThe hospital or surgery center$2,455$490 to $4,365

How much rates vary

Facilitymedian $2,455 · 10th to 90th $170 to $10,233Professionalmedian $145 · 10th to 90th $95 to $234
$1.0$10.0$100.0$1.0K$10.0Kfacility $2,455professional $145

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$3,019.95
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$234.42
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$1,995.26
Typical High
$3,981.07
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$128.82
Typical High
$218.78
CareSource
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$114.82
Typical High
$154.88
CareSource
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$338.84
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$208.93
Typical High
$616.60
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$331.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$48.98
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$158.49
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$562.34
Typical High
$2,290.87
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$147.91
Typical High
$251.19

Where Ohio sits

The same service costs 22.8 times more in New Jersey than in Maryland. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Physician feeFacility feeOhio $2,599 · 16th of 50
NJ $6,043MD $265

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.