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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.

Facilitymedian $4,571 · 10th–90th $933$12,5890%10%10th90th$4,571Professionalmedian $813 · 10th–90th $589$1,3180%20%10th90th$813$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$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