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Custom Mould For A Made-To-Measure Breast Implant

Arizona 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 $3,548 · 10th–90th $316$7,7620%5%10%10th90th$3,548Professionalmedian $234 · 10th–90th $123$7590%10%10th90th$234$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$4,466.84
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$229.09
Typical High
$758.58
BCBS
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$1,778.28
Typical High
$3,467.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$245.47
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$2,818.38
Typical High
$2,818.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$234.42
Typical High
$446.68
Medica
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$269.15
Typical High
$5,754.40
Medica
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$338.84
Typical High
$2,041.74
United
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,890.45
Typical High
$7,079.46
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$218.78
Typical High
$407.38