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Nasolabial Fistula Repair

Missouri 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?

$955

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $955 for this service. The price depends on where it is billed: about $871 from a physician practice, and about $3,548 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$871$741 to $1,122
FacilityA hospital or hospital-owned outpatient department$3,548$1,698 to $5,012

How much rates vary

Facilitymedian $3,548 · 10th to 90th $851 to $7,413Professionalmedian $871 · 10th to 90th $631 to $1,905
$200.0$500.0$1.0K$2.0K$5.0K$10.0K$20.0Kfacility $3,548professional $871

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
$794.33
Median
$3,801.89
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$831.76
Typical High
$2,137.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$4,570.88
Typical High
$8,317.64
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$891.25
Typical High
$1,348.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$891.25
Typical High
$1,318.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$3,311.31
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$933.25
Typical High
$1,513.56
Medica
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$1,071.52
Typical High
$2,754.23
Medica
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,479.11
Typical High
$6,456.54
United
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,019.95
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$912.01
Typical High
$1,584.89

Where Missouri 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.

Missouri $955 · 20th 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.