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Drainage of an Abscess Near the Tonsil

West 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?

$728

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

Insurers have agreed to pay about $728 for this procedure. That total is two separate charges: $191 to the doctor who performs it, and $537 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 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$191$158 to $282
Facility feeThe hospital or surgery center$537$204 to $813

How much rates vary

Facilitymedian $537 · 10th to 90th $145 to $813Professionalmedian $191 · 10th to 90th $132 to $288
$100$200$500$1Kfacility $537professional $191

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
$144.54
Median
$537.03
Typical High
$812.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$288.40
CareSource
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$173.78
CareSource
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$213.80
Typical High
$1,122.02
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$549.54
Typical High
$6,760.83
United
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$407.38
Typical High
$977.24
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$295.12

Where West 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

West Virginia· 35th of 51

$728

$191 physician + $537 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.