go back

Custom Mould For A Made-To-Measure Breast Implant

Massachusetts 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 $2,089 · 10th–90th $166$5,6230%10%10th90th$2,089Professionalmedian $288 · 10th–90th $123$7410%5%10%10th90th$288$100.0$500.0$2.0K$10.0K$50.0K

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
$229.09
Median
$3,090.30
Typical High
$4,897.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$229.09
Typical High
$630.96
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$4,570.88
Typical High
$9,120.11
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$323.59
Typical High
$831.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$389.05
Cigna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$389.05
Typical High
$776.25
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$186.21
Typical High
$3,630.78
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$416.87
Typical High
$524.81
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$5,248.07
Typical High
$11,220.18
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$331.13
Typical High
$758.58
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$4,570.88
Typical High
$9,120.11
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$323.59
Typical High
$831.76
United
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$5,248.07
Typical High
$11,220.18
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$354.81
Typical High
$776.25