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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.

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

$263

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $263 for this service. The price depends on where it is billed: about $234 from a physician practice, and about $3,548 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 5 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$234$145 to $295
FacilityA hospital or hospital-owned outpatient department$3,548$2,042 to $5,129

How much rates vary

Facilitymedian $3,548 · 10th to 90th $316 to $7,762Professionalmedian $234 · 10th to 90th $123 to $759
$100$200$500$1K$2K$5Kfacility $3,548professional $234

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
$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

Where Arizona 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.

Arizona· 31st of 51

$263

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.