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Excision of a Milk Duct Fistula

Illinois 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?

$575

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $575 for this service. The price depends on where it is billed: about $437 from a physician practice, and about $1,778 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 6 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$437$331 to $692
FacilityA hospital or hospital-owned outpatient department$1,778$832 to $4,467

How much rates vary

Facilitymedian $1,778 · 10th to 90th $437 to $6,457Professionalmedian $437 · 10th to 90th $275 to $891
$500$1K$2K$5K$10K$20Kfacility $1,778professional $437

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
$436.52
Median
$1,621.81
Typical High
$6,165.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$398.11
Typical High
$891.25
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$5,495.41
Typical High
$7,079.46
BCBS
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$588.84
Typical High
$870.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$524.81
Typical High
$831.76
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$676.08
Typical High
$1,621.81
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$416.87
Typical High
$630.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,548.13
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$501.19
Typical High
$891.25

Where Illinois 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.

Illinois· 22nd of 51

$575

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.