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Nasolabial Fistula Repair

Tennessee 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?

$871

Typical negotiated rate. In Tennessee, July 2026.

Insurers have agreed to pay about $871 for this service. The price depends on where it is billed: about $871 from a physician practice, and about $3,020 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 5 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$871$708 to $1,047
FacilityA hospital or hospital-owned outpatient department$3,020$2,239 to $5,370

How much rates vary

Facilitymedian $3,020 · 10th to 90th $1,096 to $9,120Professionalmedian $871 · 10th to 90th $646 to $1,413
$1.0$10.0$100.0$1.0K$10.0Kfacility $3,020professional $871

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
$870.96
Median
$2,570.40
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$851.14
Typical High
$1,258.93
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$6,165.95
Typical High
$9,772.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,122.02
Typical High
$1,819.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$3,162.28
Typical High
$6,309.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$912.01
Typical High
$1,513.56
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$16,982.44
Median
$33,884.42
Typical High
$33,884.42
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$6,165.95
Median
$7,244.36
Typical High
$7,244.36
United
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$3,311.31
Typical High
$6,025.60
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$891.25
Typical High
$1,513.56

Where Tennessee 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.

Tennessee $871 · 34th 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.