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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.

Facilitymedian $10,965 · 10th–90th $1,047$18,6210%10%10th90th$10,965Professionalmedian $229 · 10th–90th $117$3720%10%20%10th90th$229$100.0$500.0$2.0K$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
$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