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Drainage of an Abscess Near the Tonsil

Virginia 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?

$464

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

Insurers have agreed to pay about $464 for this procedure. That total is two separate charges: $195 to the doctor who performs it, and $269 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$195$155 to $240
Facility feeThe hospital or surgery center$269$186 to $1,148

How much rates vary

Facilitymedian $269 · 10th to 90th $151 to $3,236Professionalmedian $195 · 10th to 90th $132 to $339
$100$200$500$1K$2K$5K$10Kfacility $269professional $195

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
$213.80
Median
$524.81
Typical High
$5,370.32
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$186.21
Typical High
$323.59
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$2,570.40
Typical High
$2,951.21
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$213.80
Typical High
$338.84
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$144.54
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$141.25
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$363.08
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$245.47
Typical High
$489.78
Medcost
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$251.19
Typical High
$371.54
Medcost
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$213.80
Typical High
$354.81
Medcost
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$389.05
Sentara
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$588.84
Sentara
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$229.09
Typical High
$831.76
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$691.83
Typical High
$2,398.83
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$323.59

Where Virginia 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

Virginia· 47th of 51

$464

$195 physician + $269 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.