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Nasolabial Fistula Repair

West 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?

$794

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $794 for this service. The price depends on where it is billed: about $794 from a physician practice, and about $832 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 4 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$794$661 to $912
FacilityA hospital or hospital-owned outpatient department$832$661 to $1,023

How much rates vary

Facilitymedian $832 · 10th to 90th $661 to $2,344Professionalmedian $794 · 10th to 90th $617 to $1,096
$500.0$1.0K$2.0K$5.0K$10.0Kfacility $832professional $794

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
$660.69
Median
$831.76
Typical High
$1,412.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$1,023.29
CareSource
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$851.14
CareSource
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$954.99
Typical High
$4,073.80
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$2,951.21
Typical High
$16,595.87
United
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$812.83
Typical High
$1,318.26

Where West Virginia 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.

West Virginia $794 · 51st 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.