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Custom Mould For A Made-To-Measure Breast Implant

Delaware 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 $4,898 · 10th–90th $151$7,2440%20%40%10th90th$4,898Professionalmedian $229 · 10th–90th $123$4270%10%20%10th90th$229$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$4,897.79
Median
$4,897.79
Typical High
$7,244.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$229.09
Typical High
$758.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$208.93
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$194.98
Typical High
$416.87