go back

Nasolabial Fistula Repair

Montana 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?

$1,122

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $1,122 for this service. The price depends on where it is billed: about $912 from a physician practice, and about $1,202 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 5 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$912$776 to $1,380
FacilityA hospital or hospital-owned outpatient department$1,202$1,122 to $1,479

How much rates vary

Facilitymedian $1,202 · 10th to 90th $871 to $1,698Professionalmedian $912 · 10th to 90th $661 to $1,905
$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0Kfacility $1,202professional $912

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
Professional
Modifier
Global
Typical Low
$660.69
Median
$794.33
Typical High
$3,715.35
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,071.52
Typical High
$1,071.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,047.13
Typical High
$2,630.27
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,380.38
Typical High
$1,621.81
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,380.38
Typical High
$1,621.81
Providence
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$1,096.48
Typical High
$1,949.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$1,318.26
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,202.26
Typical High
$1,621.81

Where Montana 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.

Montana $1,122 · 11th 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.