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Nasolabial Fistula Repair

Colorado 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?

$912

Typical negotiated rate. In Colorado, July 2026.

Insurers have agreed to pay about $912 for this service. The price depends on where it is billed: about $891 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 7 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$891$724 to $1,096
FacilityA hospital or hospital-owned outpatient department$3,311$1,047 to $9,772

How much rates vary

Facilitymedian $3,311 · 10th to 90th $794 to $16,218Professionalmedian $891 · 10th to 90th $661 to $1,445
$200.0$500.0$1.0K$2.0K$5.0K$10.0K$20.0Kfacility $3,311professional $891

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
$891.25
Median
$5,370.32
Typical High
$8,912.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$851.14
Typical High
$1,258.93
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,165.95
Median
$11,481.54
Typical High
$19,498.45
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,071.52
Typical High
$1,621.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$891.25
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,000.00
Typical High
$1,548.82
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,000.00
Typical High
$1,548.82
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$891.25
Typical High
$3,388.44
Select Health
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,174.90
Typical High
$1,819.70
Select Health
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$724.44
Typical High
$1,047.13
United
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$4,897.79
Typical High
$10,471.29
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,023.29
Typical High
$1,621.81

Where Colorado sits

The same service costs 2.2 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Colorado $912 · 25th of 51
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.