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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 July 2026.

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

$224

Typical physician fee. In Hawaii, July 2026.

Insurers have agreed to pay about $224 for this service. Most negotiated rates run $120 to $302.

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 $4,467 · 10th to 90th $1,778 to $4,467Professionalmedian $178 · 10th to 90th $110 to $347
$50$100$200$500$1K$2K$5Kfacility $4,467professional $178

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$4,466.84
Typical High
$4,466.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$154.88
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$275.42
Typical High
$354.81
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$316.23
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$2,238.72
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$245.47
Typical High
$398.11
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$165.96
Typical High
$346.74

Where Hawaii sits

The same service costs 21.4 times more in California than in West Virginia. 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· 50th of 51

$224

CA $4,571WV $214

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.