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Custom Mould For A Made-To-Measure Breast Implant

Michigan 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 $4,074 · 10th–90th $316$6,9180%20%10th90th$4,074Professionalmedian $229 · 10th–90th $123$3160%10%10th90th$229$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
$316.23
Median
$4,073.80
Typical High
$5,754.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$316.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$295.12
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$263.03
Typical High
$501.19
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$4,073.80
Typical High
$5,754.40
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$288.40
Typical High
$389.05
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$6,456.54
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$239.88
Typical High
$398.11