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Custom Mould For A Made-To-Measure Breast Implant

Georgia 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 $4,365 · 10th–90th $339$7,9430%10%10th90th$4,365Professionalmedian $251 · 10th–90th $129$4790%10%20%10th90th$251$10.0$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
$223.87
Median
$4,570.88
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$234.42
Typical High
$426.58
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$3,801.89
Typical High
$6,760.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$269.15
Typical High
$501.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$602.56
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$295.12
Typical High
$446.68
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$5,011.87
Typical High
$8,511.38
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$263.03
Typical High
$512.86