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Nasolabial Fistula Repair

Massachusetts 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 Massachusetts, July 2026.

Insurers have agreed to pay about $977 for this service. The price depends on where it is billed: about $955 from a physician practice, and about $2,291 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 8 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$955$741 to $1,479
FacilityA hospital or hospital-owned outpatient department$2,291$832 to $3,802

How much rates vary

Facilitymedian $2,291 · 10th to 90th $759 to $5,370Professionalmedian $955 · 10th to 90th $661 to $2,138
$1.0$10.0$100.0$1.0K$10.0Kfacility $2,291professional $955

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
$870.96
Median
$3,235.94
Typical High
$5,248.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$794.33
Typical High
$1,905.46
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$4,677.35
Typical High
$33,884.42
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,122.02
Typical High
$6,165.95
BCBS
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$1,819.70
BCBS
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$3,311.31
Typical High
$3,311.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$912.01
Typical High
$5,754.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$1,071.52
Typical High
$2,089.30
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$851.14
Typical High
$3,311.31
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,148.15
Typical High
$1,737.80
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$3,801.89
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,174.90
Typical High
$2,137.96
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$4,677.35
Typical High
$33,884.42
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,122.02
Typical High
$6,165.95
United
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$3,890.45
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,230.27
Typical High
$2,290.87

Where Massachusetts 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.

Massachusetts $977 · 17th 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.