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Custom Mould For A Made-To-Measure Breast Implant

California 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 $7,413 · 10th–90th $2,692$15,8490%5%10%10th90th$7,413Professionalmedian $245 · 10th–90th $120$1,0230%5%10%10th90th$245$50.0$200.0$1.0K$5.0K$20.0K

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
$2,630.27
Median
$6,760.83
Typical High
$19,054.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$239.88
Typical High
$1,819.70
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,570.88
Median
$7,943.28
Typical High
$15,848.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$295.12
Typical High
$691.83
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$7,762.47
Typical High
$16,218.10
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$181.97
Typical High
$457.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,290.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$281.84
Typical High
$645.65
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$257.04
Typical High
$489.78
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$295.12
Typical High
$549.54
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
Typical High
$8,912.51
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,290.87
Typical High
$2,290.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$380.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$275.42
Typical High
$489.78
Providence
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$281.84
Typical High
$602.56
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$954.99
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$323.59
Typical High
$416.87
United
Setting
Facility
Modifier
Global
Typical Low
$5,248.07
Median
$9,772.37
Typical High
$20,892.96
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$239.88
Typical High
$602.56