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Nasolabial Fistula Repair

Kentucky 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?

$794

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $794 for this service. The price depends on where it is billed: about $759 from a physician practice, and about $3,715 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 6 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$759$646 to $912
FacilityA hospital or hospital-owned outpatient department$3,715$2,188 to $7,586

How much rates vary

Facilitymedian $3,715 · 10th to 90th $851 to $9,550Professionalmedian $759 · 10th to 90th $603 to $1,122
$50.0$200.0$1.0K$5.0Kfacility $3,715professional $759

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
$758.58
Median
$1,047.13
Typical High
$9,772.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$794.33
Typical High
$1,047.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$4,073.80
Typical High
$9,549.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$707.95
Typical High
$954.99
CareSource
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$758.58
Typical High
$1,000.00
CareSource
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$776.25
Typical High
$1,000.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$2,290.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$977.24
Typical High
$4,073.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$870.96
United
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$3,388.44
Typical High
$6,025.60
United
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$870.96
Typical High
$1,412.54

Where Kentucky 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.

Kentucky $794 · 50th 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.