go back

Nasolabial Fistula Repair

Washington, DC 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?

$851

Typical physician fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $851 for this service. Most negotiated rates run $741 to $1,023.

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.

How much rates vary

Facilitymedian $4,266 · 10th to 90th $794 to $7,762Professionalmedian $794 · 10th to 90th $646 to $1,047
$500.0$1.0K$2.0K$5.0K$10.0K$20.0Kfacility $4,266professional $794

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
$4,073.80
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$794.33
Typical High
$1,023.29
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$707.95
Typical High
$4,677.35
Cigna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$912.01
Typical High
$2,344.23
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$954.99
Typical High
$1,698.24
United
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$10,000.00
Typical High
$30,902.95
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$870.96
Typical High
$1,778.28

Where Washington, DC 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.

Washington, DC $851 · 39th 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.