go back

Drainage of an Abscess Near the Tonsil

Kentucky 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?

$1,727

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

Insurers have agreed to pay about $1,727 for this procedure. That total is two separate charges: $178 to the doctor who performs it, and $1,549 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$178$135 to $224
Facility feeThe hospital or surgery center$1,549$355 to $2,512

How much rates vary

Facilitymedian $1,549 · 10th to 90th $224 to $3,388Professionalmedian $178 · 10th to 90th $126 to $380
$100$200$500$1K$2K$5Kfacility $1,549professional $178

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
$199.53
Median
$363.08
Typical High
$4,168.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$758.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$2,137.96
Typical High
$2,951.21
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$158.49
Typical High
$229.09
CareSource
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$199.53
CareSource
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$154.88
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$223.87
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$213.80
Typical High
$1,122.02
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$602.56
Typical High
$1,949.84
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$186.21
Typical High
$309.03

Where Kentucky 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

Kentucky· 15th of 51

$1,727

$178 physician + $1,549 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.