go back

Nasolabial Fistula Repair

Iowa 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?

$1,122

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $1,122 for this service. The price depends on where it is billed: about $1,096 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$1,096$794 to $1,514
FacilityA hospital or hospital-owned outpatient department$4,266$1,380 to $6,457

How much rates vary

Facilitymedian $4,266 · 10th to 90th $912 to $10,965Professionalmedian $1,096 · 10th to 90th $661 to $3,715
$1K$2K$5K$10Kfacility $4,266professional $1,096

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
$1,148.15
Median
$5,011.87
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$912.01
Typical High
$3,715.35
Cigna
Setting
Facility
Modifier
Global
Typical Low
$7,244.36
Median
$7,244.36
Typical High
$7,244.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,548.82
Typical High
$2,511.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$1,288.25
Typical High
$3,162.28
Medica
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$1,479.11
Typical High
$8,317.64
Medica
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,737.80
Typical High
$6,456.54
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,778.28
Typical High
$2,290.87
Midlands
Setting
Facility
Modifier
Global
Typical Low
$7,244.36
Median
$7,244.36
Typical High
$7,244.36
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,659.59
Typical High
$2,398.83
United
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$7,413.10
Typical High
$15,488.17
United
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,122.02
Typical High
$2,089.30
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,445.44
Typical High
$2,089.30

Where Iowa 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.

Iowa· 9th of 51

$1,122

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.