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Excision of a Milk Duct Fistula

West 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?

$398

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $398 for this service. The price depends on where it is billed: about $398 from a physician practice, and about $427 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 4 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$398$316 to $490
FacilityA hospital or hospital-owned outpatient department$427$309 to $427

How much rates vary

Facilitymedian $427 · 10th to 90th $309 to $1,738Professionalmedian $398 · 10th to 90th $282 to $513
$200$500$1K$2K$5K$10Kfacility $427professional $398

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
$426.58
Typical High
$1,412.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$389.05
Typical High
$512.86
CareSource
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$416.87
CareSource
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$1,862.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$489.78
Typical High
$3,388.44
United
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$2,951.21
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$380.19
Typical High
$660.69

Where West 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.

West Virginia· 50th of 51

$398

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.