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Custom Mould For A Made-To-Measure Breast Implant

Connecticut 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 $7,586 · 10th–90th $4,571$11,7490%10%20%10th90th$7,586Professionalmedian $257 · 10th–90th $129$6460%10%10th90th$257$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
$3,981.07
Median
$6,918.31
Typical High
$9,549.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$251.19
Typical High
$707.95
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$7,413.10
Median
$12,302.69
Typical High
$13,803.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$331.13
Typical High
$676.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$302.00
Typical High
$741.31
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$5,754.40
Median
$8,709.64
Typical High
$12,882.50
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$281.84
Typical High
$562.34