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Nasolabial Fistula Repair

South Dakota 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 $1,148 · 10th–90th $646$3,0900%5%10%10th90th$1,148Professionalmedian $1,175 · 10th–90th $631$1,9950%10%10th90th$1,175$500.0$1.0K$2.0K$5.0K$10.0K

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
$660.69
Median
$4,365.16
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$741.31
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,819.70
Typical High
$2,511.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$1,071.52
Typical High
$2,238.72
Medica
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,479.11
Typical High
$6,456.54
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,659.59
Typical High
$1,862.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,698.24
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,288.25
Typical High
$1,659.59
United
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$2,691.53
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,174.90
Typical High
$1,995.26
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,513.56
Typical High
$2,187.76