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Nasolabial Fistula Repair

Vermont 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 physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $871 for this service. Most negotiated rates run $741 to $933.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $871 · 10th to 90th $724 to $1,072
$1K$2Kprofessional $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
Professional
Modifier
Global
Typical Low
$724.44
Median
$870.96
Typical High
$954.99
Cigna
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$1,000.00
Typical High
$1,479.11
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,148.15
Typical High
$2,137.96
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,071.52
Typical High
$1,819.70

Where Vermont 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.

Vermont· 33rd of 51

$871

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.