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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.

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

$417

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $417 for this service. The price depends on where it is billed: about $380 from a physician practice, and about $4,786 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$380$214 to $661
FacilityA hospital or hospital-owned outpatient department$4,786$741 to $6,761

How much rates vary

Facilitymedian $4,786 · 10th to 90th $380 to $9,772Professionalmedian $380 · 10th to 90th $135 to $1,096
$200$500$1K$2K$5K$10Kfacility $4,786professional $380

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
$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

Where Iowa 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.

Iowa· 9th of 51

$417

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.