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Custom Mould For A Made-To-Measure Breast Implant

Colorado 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 $6,918 · 10th–90th $275$14,1250%5%10th90th$6,918Professionalmedian $240 · 10th–90th $129$5010%10%20%10th90th$240$100.0$500.0$2.0K$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
$275.42
Median
$5,495.41
Typical High
$8,912.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$239.88
Typical High
$380.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,786.30
Median
$9,772.37
Typical High
$19,054.61
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$288.40
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$281.84
Typical High
$537.03
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$269.15
Typical High
$426.58
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$426.58
Typical High
$1,318.26
Select Health
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$251.19
Typical High
$630.96
Select Health
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$144.54
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$6,918.31
Typical High
$15,848.93
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$537.03