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Nasolabial Fistula Repair

New Jersey 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?

$871

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $871 for this service. The price depends on where it is billed: about $851 from a physician practice, and about $7,079 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$851$676 to $1,122
FacilityA hospital or hospital-owned outpatient department$7,079$4,898 to $10,233

How much rates vary

Facilitymedian $7,079 · 10th to 90th $1,479 to $11,749Professionalmedian $851 · 10th to 90th $603 to $1,738
$200.0$500.0$1.0K$2.0K$5.0K$10.0K$20.0Kfacility $7,079professional $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
$1,258.93
Median
$7,244.36
Typical High
$11,748.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$794.33
Typical High
$1,445.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$954.99
Typical High
$1,862.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,202.26
Typical High
$1,737.80
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$12,882.50
Median
$19,054.61
Typical High
$27,542.29
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$933.25
Typical High
$1,862.09
United
Setting
Facility
Modifier
Global
Typical Low
$2,511.89
Median
$5,888.44
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$831.76
Typical High
$1,698.24

Where New Jersey 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.

New Jersey $871 · 35th 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.