go back

Nasolabial Fistula Repair

Florida 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 Florida, July 2026.

Insurers have agreed to pay about $832 for this service. The price depends on where it is billed: about $794 from a physician practice, and about $6,918 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$794$661 to $933
FacilityA hospital or hospital-owned outpatient department$6,918$2,884 to $10,965

How much rates vary

Facilitymedian $6,918 · 10th to 90th $1,047 to $14,125Professionalmedian $794 · 10th to 90th $603 to $1,202
$1.0$10.0$100.0$1.0K$10.0Kfacility $6,918professional $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
$776.25
Median
$6,025.60
Typical High
$12,022.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$1,148.15
AvMed
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$4,073.80
Typical High
$11,220.18
AvMed
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$758.58
Typical High
$933.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$2,454.71
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$954.99
Typical High
$1,584.89
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$5,623.41
Median
$12,022.64
Typical High
$23,442.29
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$691.83
Typical High
$1,023.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$512.86
Typical High
$1,047.13
United
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$5,370.32
Typical High
$9,772.37
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$794.33
Typical High
$1,412.54
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$660.69
Typical High
$891.25

Where Florida 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.

Florida $832 · 47th 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.