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Nasolabial Fistula Repair

Ohio 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 Ohio, July 2026.

Insurers have agreed to pay about $851 for this service. The price depends on where it is billed: about $813 from a physician practice, and about $4,571 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 8 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$813$676 to $977
FacilityA hospital or hospital-owned outpatient department$4,571$2,138 to $8,913

How much rates vary

Facilitymedian $4,571 · 10th to 90th $933 to $12,589Professionalmedian $813 · 10th to 90th $589 to $1,318
$500$1K$2K$5K$10Kfacility $4,571professional $813

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
$912.01
Median
$5,128.61
Typical High
$12,589.25
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
$1,071.52
Median
$3,388.44
Typical High
$16,982.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$776.25
Typical High
$1,230.27
CareSource
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$707.95
Typical High
$3,630.78
CareSource
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$794.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$1,023.29
Typical High
$4,897.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$954.99
Typical High
$1,659.59
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$1,148.15
Typical High
$4,897.79
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$954.99
Typical High
$1,584.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$9,120.11
Median
$9,120.11
Typical High
$9,120.11
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$891.25
Typical High
$1,621.81
United
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$4,466.84
Typical High
$8,128.31
United
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$851.14
Typical High
$1,412.54

Where Ohio sits

The same service costs 2.2 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Ohio· 37th of 51

$851

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.