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Custom Mould For A Made-To-Measure Breast Implant

Florida 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 $6,761 · 10th–90th $933$14,1250%10%10th90th$6,761Professionalmedian $224 · 10th–90th $120$3890%10%20%10th90th$224$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
$776.25
Median
$4,677.35
Typical High
$11,481.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$223.87
Typical High
$389.05
AvMed
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$4,073.80
Typical High
$12,302.69
AvMed
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$213.80
Typical High
$316.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$1,548.82
Typical High
$1,819.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$257.04
Typical High
$489.78
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$6,165.95
Median
$12,302.69
Typical High
$23,442.29
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$213.80
Typical High
$275.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$2,290.87
Median
$7,762.47
Typical High
$12,882.50
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$239.88
Typical High
$478.63
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$223.87
Typical High
$302.00