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Nasolabial Fistula Repair

Connecticut 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 Connecticut, July 2026.

Insurers have agreed to pay about $912 for this service. The price depends on where it is billed: about $912 from a physician practice, and about $7,762 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 5 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$912$724 to $1,259
FacilityA hospital or hospital-owned outpatient department$7,762$5,623 to $10,233

How much rates vary

Facilitymedian $7,762 · 10th to 90th $4,365 to $13,183Professionalmedian $912 · 10th to 90th $646 to $1,905
$1K$2K$5K$10Kfacility $7,762professional $912

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
$3,890.45
Median
$7,079.46
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$851.14
Typical High
$1,659.59
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$8,317.64
Median
$14,125.38
Typical High
$16,595.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,445.44
Typical High
$1,995.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$5,888.44
Typical High
$8,317.64
Cigna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$1,148.15
Typical High
$2,137.96
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,380.38
Typical High
$1,737.80
United
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$7,079.46
Typical High
$11,220.18
United
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$1,122.02
Typical High
$2,398.83

Where Connecticut 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.

Connecticut· 28th of 51

$912

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.