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Excision of a Milk Duct Fistula

Utah 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?

$525

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $525 for this service. The price depends on where it is billed: about $479 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 7 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$479$417 to $692
FacilityA hospital or hospital-owned outpatient department$4,571$3,162 to $7,413

How much rates vary

Facilitymedian $4,571 · 10th to 90th $309 to $8,913Professionalmedian $479 · 10th to 90th $309 to $832
$50$200$1K$5Kfacility $4,571professional $479

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
$309.03
Median
$4,570.88
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$446.68
Typical High
$812.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$524.81
Typical High
$776.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$741.31
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$5,495.41
Median
$7,585.78
Typical High
$11,481.54
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$575.44
Typical High
$794.33
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00
Select Health
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$891.25
Typical High
$1,047.13
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$616.60
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$5,128.61
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$457.09
Typical High
$812.83

Where Utah 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.

Utah· 28th of 51

$525

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.