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Custom Mould For A Made-To-Measure Breast Implant

Louisiana 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 $2,570 · 10th–90th $447$6,6070%5%10%10th90th$2,570Professionalmedian $245 · 10th–90th $135$3630%10%10th90th$245$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
$309.03
Median
$1,905.46
Typical High
$4,570.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$218.78
Typical High
$363.08
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$6,025.60
Typical High
$9,120.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$251.19
Typical High
$316.23
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$263.03
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$3,715.35
Typical High
$8,912.51
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$239.88
Typical High
$446.68