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Custom Mould For A Made-To-Measure Breast Implant

Kansas 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 $3,631 · 10th–90th $257$9,5500%5%10%10th90th$3,631Professionalmedian $240 · 10th–90th $126$4680%10%20%10th90th$240$100.0$200.0$500.0$1.0K$2.0K$5.0K$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
$288.40
Median
$3,801.89
Typical High
$10,471.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$199.53
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$467.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12,589.25
Median
$12,589.25
Typical High
$12,589.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$288.40
Typical High
$501.19
Medica
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$323.59
Typical High
$5,888.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$354.81
Typical High
$2,041.74
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$2,951.21
Typical High
$6,456.54
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$229.09
Typical High
$426.58