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Excision of a Milk Duct Fistula

North Carolina 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?

$468

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $468 for this service. The price depends on where it is billed: about $468 from a physician practice, and about $692 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$468$355 to $692
FacilityA hospital or hospital-owned outpatient department$692$457 to $1,660

How much rates vary

Facilitymedian $692 · 10th to 90th $316 to $7,943Professionalmedian $468 · 10th to 90th $316 to $1,148
$500$1K$2K$5K$10Kfacility $692professional $468

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
$316.23
Median
$691.83
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$457.09
Typical High
$1,148.15
BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$575.44
Typical High
$1,023.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$575.44
Typical High
$977.24
Medcost
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$467.74
Typical High
$758.58
Medcost
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$1,202.26
United
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$6,918.31
Typical High
$12,882.50
United
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$436.52
Typical High
$851.14
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$8,912.51
Median
$8,912.51
Typical High
$45,708.82
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,890.45

Where North Carolina 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.

North Carolina· 36th of 51

$468

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.