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Custom Mould For A Made-To-Measure Breast Implant

Kentucky 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 $1,122 · 10th–90th $135$10,7150%5%10%10th90th$1,122Professionalmedian $224 · 10th–90th $123$3720%10%20%10th90th$224$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
$134.90
Median
$616.60
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$223.87
Typical High
$416.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$7,244.36
Median
$10,715.19
Typical High
$11,220.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$194.98
Typical High
$346.74
CareSource
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$177.83
Typical High
$213.80
CareSource
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$218.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$223.87
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$281.84
Typical High
$2,137.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$4,677.35
Typical High
$8,511.38
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$467.74