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Custom Mould For A Made-To-Measure Breast Implant

Idaho 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 $2,951 · 10th–90th $204$9,7720%5%10%10th90th$2,951Professionalmedian $282 · 10th–90th $182$5130%10%20%10th90th$282$50.0$200.0$1.0K$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
$2,884.03
Median
$4,466.84
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$269.15
Typical High
$416.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$5,128.61
Typical High
$9,772.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$416.87
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$269.15
Typical High
$489.78
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$275.42
Typical High
$588.84
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$323.59
Typical High
$588.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$7,244.36
Median
$8,511.38
Typical High
$12,589.25
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$269.15
Typical High
$478.63
Select Health
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$4,365.16
Typical High
$7,079.46
Select Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$269.15
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$16,982.44
Typical High
$18,197.01
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$257.04
Typical High
$512.86