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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 October 2026.

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

$955

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $955 for this service. The price depends on where it is billed: about $692 from a physician practice, and about $3,715 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$692$479 to $1,096
FacilityA hospital or hospital-owned outpatient department$3,715$2,455 to $7,413

How much rates vary

Facilitymedian $3,715 · 10th to 90th $1,000 to $12,023Professionalmedian $692 · 10th to 90th $251 to $1,259
$100$200$500$1K$2K$5K$10Kfacility $3,715professional $692

Distribution of negotiated rates across all payers (price axis is log-scale). 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
None
Typical Low
$1,258.93
Median
$10,715.19
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$691.83
Typical High
$12,882.50
Cigna
Setting
Facility
Modifier
None
Typical Low
$2,454.71
Median
$4,073.80
Typical High
$12,589.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$346.74
Typical High
$891.25
Moda Health
Setting
Facility
Modifier
None
Typical Low
$213.80
Median
$691.83
Typical High
$1,819.70
Moda Health
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$794.33
Typical High
$1,819.70
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$2,344.23
Median
$3,467.37
Typical High
$4,466.84
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$575.44
Median
$575.44
Typical High
$1,096.48
Providence
Setting
Facility
Modifier
None
Typical Low
$933.25
Median
$3,388.44
Typical High
$7,413.10
Providence
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$316.23
Typical High
$602.56
United
Setting
Facility
Modifier
None
Typical Low
$2,570.40
Median
$7,079.46
Typical High
$10,471.29
United
Setting
Professional
Modifier
None
Typical Low
$269.15
Median
$707.95
Typical High
$1,659.59

Where Alaska sits

The same service costs 5.8 times more in Alaska than in Hawaii. 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· 1st of 51

$955

AK $955HI $166

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.