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Nasolabial Fistula Repair

Michigan 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 Michigan, July 2026.

Insurers have agreed to pay about $851 for this service. The price depends on where it is billed: about $851 from a physician practice, and about $4,898 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$851$724 to $955
FacilityA hospital or hospital-owned outpatient department$4,898$1,096 to $5,754

How much rates vary

Facilitymedian $4,898 · 10th to 90th $851 to $6,918Professionalmedian $851 · 10th to 90th $646 to $1,096
$200.0$500.0$1.0K$2.0K$5.0K$10.0Kfacility $4,898professional $851

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
$851.14
Median
$4,897.79
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$831.76
Typical High
$1,096.48
BCBS
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
BCBS
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$912.01
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$912.01
Typical High
$1,778.28
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$2,187.76
Typical High
$6,918.31
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$851.14
Typical High
$1,174.90
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,949.84
Typical High
$3,467.37
United
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$5,248.07
Typical High
$14,791.08
United
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$933.25
Typical High
$1,380.38

Where Michigan 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.

Michigan $851 · 42nd 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.