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Custom Mould For A Made-To-Measure Breast Implant

Indiana 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?

$251

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $251 for this service. The price depends on where it is billed: about $229 from a physician practice, and about $10,965 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 5 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$229$135 to $269
FacilityA hospital or hospital-owned outpatient department$10,965$7,079 to $16,982

How much rates vary

Facilitymedian $10,965 · 10th to 90th $1,047 to $18,621Professionalmedian $229 · 10th to 90th $117 to $372
$100$500$2K$10Kfacility $10,965professional $229

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
$199.53
Median
$4,897.79
Typical High
$11,220.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$223.87
Typical High
$309.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,456.54
Median
$14,125.38
Typical High
$19,498.45
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$239.88
Typical High
$389.05
CareSource
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$141.25
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$229.09
Typical High
$588.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$251.19
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$7,413.10
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$416.87

Where Indiana 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.

Indiana· 40th of 51

$251

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.