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Nasolabial Fistula Repair

Maine 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?

$1,000

Typical physician fee. In Maine, July 2026.

Insurers have agreed to pay about $1,000 for this service. Most negotiated rates run $794 to $1,380.

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.

How much rates vary

Facilitymedian $871 · 10th to 90th $871 to $12,023Professionalmedian $1,000 · 10th to 90th $708 to $1,995
$200.0$500.0$1.0K$2.0K$5.0K$10.0K$20.0Kfacility $871professional $1,000

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$851.14
Typical High
$1,023.29
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,071.52
Typical High
$1,737.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,023.29
Typical High
$1,949.84
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,230.27
Typical High
$2,238.72
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$870.96
Typical High
$1,412.54
United
Setting
Facility
Modifier
Global
Typical Low
$12,022.64
Median
$12,022.64
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,096.48
Typical High
$1,905.46

Where Maine 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.

Maine $1,000 · 14th 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.