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Drainage of an Abscess Near the Tonsil

Illinois rates for HCPCS 42700

This procedure drains a pocket of infection that has formed in the tissue next to a tonsil, a condition that can cause severe throat pain, difficulty swallowing, and a muffled voice. The clinician makes a small opening to release the pus and relieve pressure in the area.

Rates data updated July 2026.

How much does Drainage of an Abscess Near the Tonsil cost?

$891

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

Insurers have agreed to pay about $891 for this procedure. That total is two separate charges: $200 to the doctor who performs it, and $692 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 7 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$200$155 to $269
Facility feeThe hospital or surgery center$692$282 to $1,862

How much rates vary

Facilitymedian $692 · 10th to 90th $182 to $5,129Professionalmedian $200 · 10th to 90th $135 to $355
$100$200$500$1K$2K$5K$10Kfacility $692professional $200

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
$177.83
Median
$812.83
Typical High
$5,128.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$194.98
Typical High
$416.87
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$169.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$354.81
Typical High
$2,290.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$229.09
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$239.88
Typical High
$1,000.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$223.87
Typical High
$389.05
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$691.83
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$169.82
Typical High
$257.04
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$33.11
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$630.96
Typical High
$1,995.26
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$208.93
Typical High
$371.54

Where Illinois sits

The same service costs 15.2 times more in Delaware than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

Illinois· 30th of 51

$891

$200 physician + $692 facility

DE $5,194MD $341

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.