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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.

Facilitymedian $427 · 10th–90th $166$9,7720%5%10%10th90th$427Professionalmedian $692 · 10th–90th $178$1,4790%5%10%10th90th$692$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

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