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Custom Mould For A Made-To-Measure Breast Implant

Hawaii 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 October 2026.

How much does Custom Mould For A Made-To-Measure Breast Implant cost?

$166

Typical physician fee. In Hawaii, October 2026.

Insurers have agreed to pay about $166 for this service. Most negotiated rates run $126 to $355.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $3,890 · 10th to 90th $1,778 to $4,467Professionalmedian $166 · 10th to 90th $30 to $355
$50$100$200$500$1K$2K$5Kfacility $3,890professional $166

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$1,778.28
Median
$4,466.84
Typical High
$4,466.84
Aetna
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$154.88
Typical High
$269.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$302.00
Median
$354.81
Typical High
$354.81
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$316.23
Typical High
$436.52
United
Setting
Facility
Modifier
None
Typical Low
$2,238.72
Median
$3,019.95
Typical High
$3,890.45
United
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$354.81
Typical High
$354.81
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$29.51
Median
$125.89
Typical High
$346.74

Where Hawaii sits

The same service costs 5.8 times more in Alaska than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Hawaii· 51st of 51

$166

AK $955HI $166

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.