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Nasolabial Fistula Repair

New York 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.

Facilitymedian $5,129 · 10th–90th $955$11,7490%5%10th90th$5,129Professionalmedian $912 · 10th–90th $646$2,1880%10%10th90th$912$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$3,090.30
Typical High
$10,471.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$851.14
Typical High
$1,318.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,890.45
Median
$7,762.47
Typical High
$13,489.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$758.58
Typical High
$1,659.59
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$2,398.83
Typical High
$10,964.78
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$1,202.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$7,079.46
Cigna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$1,096.48
Typical High
$2,570.40
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$794.33
Typical High
$2,137.96
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,258.93
Typical High
$1,949.84
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,148.15
Typical High
$1,819.70
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$7,244.36
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$1,096.48
Typical High
$2,290.87
United
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$3,981.07
Typical High
$10,471.29
United
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$1,318.26
Typical High
$4,168.69
Univera
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$812.83
Typical High
$2,398.83
Univera
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,071.52
Typical High
$1,949.84