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Custom Mould For A Made-To-Measure Breast Implant

Illinois 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 $1,862 · 10th–90th $251$7,9430%5%10th90th$1,862Professionalmedian $240 · 10th–90th $123$5250%10%10th90th$240$50.0$200.0$1.0K$5.0K$20.0K

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
$251.19
Median
$1,659.59
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$229.09
Typical High
$537.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$5,011.87
Typical High
$6,760.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$281.84
Typical High
$501.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$11,220.18
Typical High
$14,125.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$288.40
Typical High
$501.19
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$380.19
Typical High
$1,023.29
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$181.97
Typical High
$363.08
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$4,365.16
Typical High
$9,332.54
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$269.15
Typical High
$512.86