go back

Nasolabial Fistula Repair

Indiana 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?

$851

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $851 for this service. The price depends on where it is billed: about $794 from a physician practice, and about $14,125 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$794$676 to $955
FacilityA hospital or hospital-owned outpatient department$14,125$5,012 to $21,878

How much rates vary

Facilitymedian $14,125 · 10th to 90th $1,380 to $25,704Professionalmedian $794 · 10th to 90th $631 to $1,202
$1K$2K$5K$10K$20Kfacility $14,125professional $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
$724.44
Median
$2,137.96
Typical High
$14,125.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$831.76
Typical High
$1,148.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,365.16
Median
$15,488.17
Typical High
$25,703.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$758.58
Typical High
$1,148.15
CareSource
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$676.08
Typical High
$758.58
CareSource
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$1,023.29
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$954.99
Typical High
$1,621.81
United
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$5,370.32
Typical High
$10,715.19
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$831.76
Typical High
$1,318.26

Where Indiana 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.

Indiana· 40th of 51

$851

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.