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Nasolabial Fistula Repair

Pennsylvania 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 Pennsylvania, 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 $4,786 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 9 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$692 to $933
FacilityA hospital or hospital-owned outpatient department$4,786$2,188 to $7,244

How much rates vary

Facilitymedian $4,786 · 10th to 90th $912 to $8,511Professionalmedian $813 · 10th to 90th $631 to $1,230
$10.0$100.0$1.0K$10.0Kfacility $4,786professional $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
$5,370.32
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$794.33
Typical High
$1,148.15
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$6,456.54
Median
$7,585.78
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,023.29
Typical High
$1,023.29
Cigna
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$2,818.38
Typical High
$8,128.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$870.96
Typical High
$1,479.11
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,318.26
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,230.27
Typical High
$1,513.56
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$4,365.16
Typical High
$5,248.07
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$891.25
Typical High
$1,479.11
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$4,786.30
Typical High
$8,511.38
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$851.14
Typical High
$1,584.89
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$794.33
Typical High
$1,995.26
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$2,187.76
Typical High
$4,073.80
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$691.83
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$3,311.31
Typical High
$17,378.01
United
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$831.76
Typical High
$1,412.54

Where Pennsylvania 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.

Pennsylvania $851 · 43rd 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.