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Custom Mould For A Made-To-Measure Breast Implant

Alaska rates for HCPCS 19396

An impression of the chest is taken and shaped so that a breast implant can be manufactured to match the individual's own contour. It is the preparatory step used when a standard, off-the-shelf implant would not fit the chest wall well, and the finished implant is placed inside the body at a later operation.

Rates data updated July 2026.

How much does Custom Mould For A Made-To-Measure Breast Implant cost?

$692

Typical negotiated rate. In Alaska, July 2026.

Insurers have agreed to pay about $692 for this service. The price depends on where it is billed: about $692 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 6 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$692$363 to $1,096
FacilityA hospital or hospital-owned outpatient department$427$263 to $1,259

How much rates vary

Facilitymedian $427 · 10th to 90th $166 to $9,772Professionalmedian $692 · 10th to 90th $178 to $1,479
$200$500$1K$2K$5K$10Kfacility $427professional $692

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$6,165.95
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$467.74
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$346.74
Typical High
$478.63
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$338.84
Typical High
$1,258.93
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$870.96
Typical High
$1,737.80
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$1,096.48
Typical High
$1,479.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$338.84
Typical High
$1,258.93
Providence
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$316.23
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$7,943.28
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$630.96
Typical High
$1,659.59

Where Alaska sits

The same service costs 21.4 times more in California than in West Virginia. 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.

Alaska· 3rd of 51

$692

CA $4,571WV $214

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.