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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.

Facilitymedian $1,122 · 10th–90th $708$7,4130%5%10%10th90th$1,122Professionalmedian $871 · 10th–90th $661$1,4130%10%10th90th$871$500.0$1.0K$2.0K$5.0K$10.0K$20.0K

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
$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