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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.

Facilitymedian $4,467 · 10th–90th $1,778$4,4670%50%10th$4,467Professionalmedian $178 · 10th–90th $110$3470%10%20%10th90th$178$50.0$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. Need provider-level prices? Contact us.

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