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Custom Mould For A Made-To-Measure Breast Implant

Maine 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 $7,943 · 10th–90th $7,943$7,9430%50%100%$7,943Professionalmedian $245 · 10th–90th $138$5130%10%10th90th$245$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$144.54
Typical High
$229.09
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$269.15
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$316.23
Typical High
$602.56
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$323.59
Typical High
$562.34
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$144.54
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$7,943.28
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$331.13
Typical High
$588.84