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Nasolabial Fistula Repair

Georgia 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?

$977

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $977 for this service. The price depends on where it is billed: about $912 from a physician practice, and about $4,266 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$912$759 to $1,230
FacilityA hospital or hospital-owned outpatient department$4,266$1,778 to $6,607

How much rates vary

Facilitymedian $4,266 · 10th to 90th $891 to $8,318Professionalmedian $912 · 10th to 90th $661 to $1,585
$100.0$500.0$2.0K$10.0Kfacility $4,266professional $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
$912.01
Median
$4,786.30
Typical High
$9,549.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$851.14
Typical High
$1,412.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$3,235.94
Typical High
$7,762.47
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,230.27
Typical High
$1,659.59
CareSource
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$1,023.29
Typical High
$3,715.35
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,000.00
Typical High
$1,737.80
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,000.00
Typical High
$1,737.80
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$3,235.94
Typical High
$6,309.57
United
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$933.25
Typical High
$1,698.24

Where Georgia 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.

Georgia $977 · 18th 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.