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Drainage of an Abscess Near the Tonsil

North Carolina 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?

$454

Typical total for the visit. In North Carolina, July 2026.

Insurers have agreed to pay about $454 for this procedure. That total is two separate charges: $240 to the doctor who performs it, and $214 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$240$186 to $355
Facility feeThe hospital or surgery center$214$178 to $363

How much rates vary

Facilitymedian $214 · 10th to 90th $132 to $794Professionalmedian $240 · 10th to 90th $141 to $550
$100$200$500$1K$2K$5Kfacility $214professional $240

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
$131.83
Median
$281.84
Typical High
$3,981.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$199.53
Typical High
$707.95
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$169.82
Typical High
$380.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$269.15
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$223.87
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$229.09
Typical High
$416.87
Medcost
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Medcost
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$204.17
Typical High
$331.13
Medcost
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$489.78
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$489.78
Typical High
$1,513.56
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$177.83
Typical High
$316.23
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$2,238.72
Typical High
$19,498.45
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,621.81

Where North Carolina 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

North Carolina· 48th of 51

$454

$240 physician + $214 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.