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Excision of a Milk Duct Fistula

Iowa rates for HCPCS 19112

Surgical removal of an abnormal tunnel-like connection, called a fistula, that has formed between a milk duct and the skin near the nipple. It is done when the opening keeps draining fluid, becomes infected, or fails to heal, often after a prior breast infection or abscess. The surgeon removes the fistula tract and the affected section of duct through a small incision near the nipple or areola.

Rates data updated July 2026.

How much does Excision of a Milk Duct Fistula cost?

$794

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $794 for this service. The price depends on where it is billed: about $692 from a physician practice, and about $4,266 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 7 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$692$468 to $1,096
FacilityA hospital or hospital-owned outpatient department$4,266$1,230 to $6,761

How much rates vary

Facilitymedian $4,266 · 10th to 90th $692 to $9,550Professionalmedian $692 · 10th to 90th $309 to $2,042
$500$1K$2K$5K$10Kfacility $4,266professional $692

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
$691.83
Median
$4,265.80
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$691.83
Typical High
$3,090.30
Cigna
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$933.25
Typical High
$1,318.26
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$676.08
Typical High
$1,737.80
Medica
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,174.90
Typical High
$9,549.93
Medica
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$870.96
Typical High
$2,398.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,000.00
Typical High
$1,288.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$870.96
Typical High
$1,288.25
United
Setting
Facility
Modifier
Global
Typical Low
$4,365.16
Median
$6,456.54
Typical High
$10,232.93
United
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$588.84
Typical High
$1,096.48
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$724.44
Typical High
$1,122.02

Where Iowa sits

The same service costs 11.5 times more in California than in Rhode Island. 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.

Iowa· 10th of 51

$794

CA $4,467RI $389

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.