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Nasolabial Fistula Repair

Alabama rates for HCPCS 42260

Surgically closes a nasolabial fistula -- an abnormal opening connecting the nose and the mouth near the upper lip. This is most often needed as a later repair following an earlier cleft lip or palate procedure.

Rates data updated July 2026.

How much does Nasolabial Fistula Repair cost?

$871

Typical negotiated rate. In Alabama, July 2026.

Insurers have agreed to pay about $871 for this service. The price depends on where it is billed: about $851 from a physician practice, and about $3,311 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$851$692 to $1,148
FacilityA hospital or hospital-owned outpatient department$3,311$1,514 to $5,623

How much rates vary

Facilitymedian $3,311 · 10th to 90th $955 to $6,918Professionalmedian $851 · 10th to 90th $617 to $1,698
$1K$2K$5K$10Kfacility $3,311professional $851

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
$794.33
Median
$1,258.93
Typical High
$2,398.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$1,698.24
BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,786.30
Median
$5,754.40
Typical High
$7,762.47
BCBS
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$1,047.13
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$954.99
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$2,951.21
Typical High
$5,623.41
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$794.33
Typical High
$1,348.96

Where Alabama sits

The same service costs 2.2 times more in Minnesota than in West Virginia. 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.

Alabama· 36th of 51

$871

MN $1,738WV $794

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.