Digestive Surgery · 42725
Drainage Of Abscess Of Throat From Outside Mouth
What Medicare pays for 42725, what providers bill, and how the price varies across 2 states, drawn from CMS 2023 claims data.
- $567.17
- Medicare pays
- $2,481.48
- Providers bill
- 4.4×
- Markup
- #7,297 of 9,297
- Volume rank
The verdict
Drainage Of Abscess Of Throat From Outside Mouth pairs modest national service volume with a below-median markup.
- 22nd pct.
- national service volume
- 30th pct.
- billed-to-Medicare markup
- 4.4×
- billed vs. Medicare
- $567.17
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Digestive Surgery, the applied ratio is 2.54x Medicare (RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
4 more affordable than 30% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$2,481.48
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Texas | $628.75 | $2,787.81 |
| California | $613.75 | $2,570.05 |
What the Data Says About Drainage Of Abscess Of Throat From Outside Mouth
Across 2 states with reporting providers, CPT code 42725 (Drainage Of Abscess Of Throat From Outside Mouth) shows a national average Medicare payment of $567.17 against an average billed charge of $2,481.48. That gap, a 4.4x markup, or 338% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Digestive Surgery procedures like this one saw 132 services billed to Medicare in 2023 by 114 distinct providers, serving 116 unique beneficiaries. State-level variation is significant: California reports the lowest average payment at $613.75, while Texas reports the highest at $628.75. At just 2%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.54x Medicare; RAND 2024 Surgery bucket (2.54x) + CMS Medicare baseline), the estimated commercial insurance price lands near $1,805.35, with self-pay cash discounts commonly bringing the figure closer to $1,215.48. Within Digestive Surgery, Drainage Of Abscess Of Throat From Outside Mouth ranks #225 of 765 tracked procedures by national average Medicare payment.
Where this sits in the registry
Drainage Of Abscess Of Throat From Outside Mouth (42725) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Digestive Surgery codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Drainage Of Abscess Of Throat From Outside Mouth rank among Medicare procedures?
According to CMS Medicare Part B claims, Drainage Of Abscess Of Throat From Outside Mouth (CPT 42725) ranks #7,297 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #225 of 765 within Digestive Surgery by national average Medicare payment. See /methodology#corpus-placement.
How much does Drainage Of Abscess Of Throat From Outside Mouth cost?
Drainage Of Abscess Of Throat From Outside Mouth (CPT 42725) is priced fairly consistently nationwide: Medicare pays $567.17 on average, and the $613.75-$628.75 state range stays relatively tight. Providers typically bill $2,481.48.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Drainage Of Abscess Of Throat From Outside Mouth cost with insurance?
Commercial insurers pay well above Medicare for drainage of abscess of throat from outside mouth, an estimated $1,805.35 on average (range: $1,263.74-$2,527.49), versus $567.17 from Medicare. Without insurance, the estimated cash price is $1,215.48.
Which state has the lowest cost for Drainage Of Abscess Of Throat From Outside Mouth?
California and Texas bookend the range for Drainage Of Abscess Of Throat From Outside Mouth, at $613.75 and $628.75 respectively - a relatively tight $15.00 spread nationwide.
How many providers perform Drainage Of Abscess Of Throat From Outside Mouth?
Drainage Of Abscess Of Throat From Outside Mouth is comparatively uncommon: only 114 providers nationally billed Medicare for it in 2023, serving 116 beneficiaries via 132 total services.
What is the billed-to-Medicare markup for Drainage Of Abscess Of Throat From Outside Mouth?
Providers bill 4.4x what Medicare pays for Drainage Of Abscess Of Throat From Outside Mouth - a below-median markup at 338% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (132 here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($567.17 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.