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Nasolabial Fistula Repair

Hawaii 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?

$891

Typical negotiated rate. In Hawaii, July 2026.

Insurers have agreed to pay about $891 for this service. The price depends on where it is billed: about $871 from a physician practice, and about $5,495 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$871$724 to $1,862
FacilityA hospital or hospital-owned outpatient department$5,495$1,950 to $5,495

How much rates vary

Facilitymedian $5,495 · 10th to 90th $1,549 to $5,495Professionalmedian $871 · 10th to 90th $661 to $6,457
$50.0$200.0$1.0K$5.0Kfacility $5,495professional $871

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
$1,621.81
Median
$5,495.41
Typical High
$5,495.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$794.33
Typical High
$1,023.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,548.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,071.52
Typical High
$2,630.27
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$977.24
Typical High
$1,258.93
United
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
United
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$912.01
Typical High
$1,318.26
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$3,311.31
Typical High
$7,943.28

Where Hawaii 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.

Hawaii $891 · 29th 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.