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Custom Mould For A Made-To-Measure Breast Implant

Iowa 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 $4,786 · 10th–90th $380$9,7720%5%10%10th90th$4,786Professionalmedian $380 · 10th–90th $135$1,0960%10%10th90th$380$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$416.87
Median
$4,265.80
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$269.15
Typical High
$1,819.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$630.96
Typical High
$794.33
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$338.84
Typical High
$1,096.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$691.83
Typical High
$9,772.37
Medica
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$478.63
Typical High
$1,174.90
Midlands
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$549.54
Typical High
$660.69
Midlands
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$436.52
Typical High
$776.25
United
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$7,943.28
Typical High
$10,232.93
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$309.03
Typical High
$676.08
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$275.42
Typical High
$645.65