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Excision of a Milk Duct Fistula

New Jersey 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?

$447

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $447 for this service. The price depends on where it is billed: about $407 from a physician practice, and about $6,761 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 5 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$407$302 to $562
FacilityA hospital or hospital-owned outpatient department$6,761$4,677 to $9,333

How much rates vary

Facilitymedian $6,761 · 10th to 90th $832 to $11,220Professionalmedian $407 · 10th to 90th $269 to $1,096
$500$1K$2K$5K$10Kfacility $6,761professional $407

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
$575.44
Median
$6,760.83
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$398.11
Typical High
$5,888.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$512.86
Typical High
$1,096.48
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$630.96
Typical High
$954.99
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$12,882.50
Typical High
$19,498.45
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$489.78
Typical High
$977.24
United
Setting
Facility
Modifier
Global
Typical Low
$2,511.89
Median
$6,165.95
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$389.05
Typical High
$870.96

Where New Jersey 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.

New Jersey· 43rd of 51

$447

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.