go back

Nasolabial Fistula Repair

Virginia 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?

$912

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $912 for this service. The price depends on where it is billed: about $871 from a physician practice, and about $1,122 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$871$741 to $1,047
FacilityA hospital or hospital-owned outpatient department$1,122$813 to $3,631

How much rates vary

Facilitymedian $1,122 · 10th to 90th $708 to $7,413Professionalmedian $871 · 10th to 90th $661 to $1,413
$1K$2K$5K$10Kfacility $1,122professional $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
$912.01
Median
$4,786.30
Typical High
$9,772.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$831.76
Typical High
$1,148.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$7,413.10
Typical High
$9,332.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,000.00
Typical High
$1,548.82
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$707.95
Typical High
$2,691.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$2,691.53
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$912.01
Typical High
$1,445.44
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,000.00
Typical High
$1,659.59
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,122.02
Typical High
$1,862.09
Medcost
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$1,000.00
Typical High
$1,548.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$1,698.24
Sentara
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$831.76
Typical High
$2,884.03
Sentara
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,023.29
Typical High
$3,630.78
United
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$5,623.41
Typical High
$13,182.57
United
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$870.96
Typical High
$1,445.44

Where Virginia 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.

Virginia· 22nd of 51

$912

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.