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Nasolabial Fistula Repair

Delaware 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?

$832

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $832 for this service. The price depends on where it is billed: about $832 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 3 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$832$708 to $977
FacilityA hospital or hospital-owned outpatient department$3,311$1,023 to $6,026

How much rates vary

Facilitymedian $3,311 · 10th to 90th $1,000 to $7,244Professionalmedian $832 · 10th to 90th $661 to $1,318
$1K$2K$5Kfacility $3,311professional $832

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$6,025.60
Median
$6,025.60
Typical High
$7,244.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$831.76
Typical High
$1,318.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$2,818.38
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$891.25
Typical High
$1,513.56
United
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,000.00
Typical High
$1,479.11
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$794.33
Typical High
$1,258.93

Where Delaware 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.

Delaware· 48th of 51

$832

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.