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Excision of a Milk Duct Fistula

Virginia 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?

$490

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $490 for this service. The price depends on where it is billed: about $468 from a physician practice, and about $3,388 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 8 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 $562
FacilityA hospital or hospital-owned outpatient department$3,388$490 to $6,607

How much rates vary

Facilitymedian $3,388 · 10th to 90th $347 to $8,710Professionalmedian $468 · 10th to 90th $316 to $977
$500$1K$2K$5K$10Kfacility $3,388professional $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
$489.78
Median
$4,786.30
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$426.58
Typical High
$3,235.94
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,888.44
Median
$6,760.83
Typical High
$7,413.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$501.19
Typical High
$794.33
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$489.78
Typical High
$4,365.16
Cigna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$489.78
Typical High
$870.96
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$588.84
Typical High
$1,584.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$616.60
Typical High
$1,096.48
Medcost
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$501.19
Typical High
$812.83
Sentara
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$416.87
Typical High
$8,709.64
Sentara
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$602.56
Typical High
$8,709.64
United
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$6,606.93
Typical High
$13,489.63
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$446.68
Typical High
$776.25

Where Virginia 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.

Virginia· 31st of 51

$490

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.