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Excision of a Milk Duct Fistula

Ohio 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?

$501

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $501 for this service. The price depends on where it is billed: about $407 from a physician practice, and about $4,074 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$407$316 to $575
FacilityA hospital or hospital-owned outpatient department$4,074$1,445 to $7,586

How much rates vary

Facilitymedian $4,074 · 10th to 90th $479 to $10,965Professionalmedian $407 · 10th to 90th $257 to $1,175
$50$200$1K$5Kfacility $4,074professional $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
$436.52
Median
$4,168.69
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$398.11
Typical High
$7,413.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,548.13
Typical High
$15,135.61
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$398.11
Typical High
$707.95
CareSource
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$323.59
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$21,379.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$478.63
Typical High
$831.76
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$21,379.62
Median
$21,379.62
Typical High
$21,379.62
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$489.78
Typical High
$831.76
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$154.88
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$524.81
Typical High
$954.99
United
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$4,168.69
Typical High
$7,762.47
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$436.52
Typical High
$758.58

Where Ohio 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.

Ohio· 30th of 51

$501

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.