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Nasolabial Fistula Repair

Oregon 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?

$1,380

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $1,380 for this service. The price depends on where it is billed: about $1,380 from a physician practice, and about $1,380 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$1,380$1,000 to $1,738
FacilityA hospital or hospital-owned outpatient department$1,380$955 to $1,698

How much rates vary

Facilitymedian $1,380 · 10th to 90th $759 to $2,089Professionalmedian $1,380 · 10th to 90th $724 to $2,188
$100$200$500$1K$2K$5K$10Kfacility $1,380professional $1,380

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
$1,698.24
Median
$2,238.72
Typical High
$18,620.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$2,511.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$5,011.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,412.54
Typical High
$2,089.30
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,479.11
Typical High
$2,041.74
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$1,047.13
Typical High
$1,778.28
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,412.54
Typical High
$2,041.74
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,584.89
Typical High
$1,698.24
Providence
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$1,047.13
Typical High
$1,778.28
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,548.82
Typical High
$2,187.76
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$13,489.63
Median
$19,054.61
Typical High
$23,442.29
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,698.24
Typical High
$2,290.87
United
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$9,549.93
Typical High
$17,782.79
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,445.44
Typical High
$2,187.76

Where Oregon 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.

Oregon· 3rd of 51

$1,380

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.