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Excision of a Milk Duct Fistula

New York 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?

$692

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $692 for this service. The price depends on where it is billed: about $427 from a physician practice, and about $4,571 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 9 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$427$331 to $708
FacilityA hospital or hospital-owned outpatient department$4,571$2,138 to $7,586

How much rates vary

Facilitymedian $4,571 · 10th to 90th $447 to $10,965Professionalmedian $427 · 10th to 90th $275 to $1,230
$200$500$1K$2K$5K$10Kfacility $4,571professional $427

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
$407.38
Median
$3,162.28
Typical High
$9,772.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$407.38
Typical High
$1,071.52
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$5,495.41
Typical High
$12,882.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$398.11
Typical High
$1,202.26
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$1,995.26
Typical High
$8,912.51
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$676.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$5,754.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$660.69
Typical High
$1,659.59
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$524.81
Typical High
$1,288.25
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$741.31
Typical High
$1,047.13
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$588.84
Typical High
$977.24
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$23,442.29
Typical High
$53,703.18
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$630.96
Typical High
$1,202.26
United
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$3,981.07
Typical High
$9,772.37
United
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$549.54
Typical High
$1,318.26
Univera
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$346.74
Typical High
$933.25
Univera
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$549.54
Typical High
$1,023.29

Where New York 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 York· 13th of 51

$692

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.