go back

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 October 2026.

How much does Custom Mould For A Made-To-Measure Breast Implant cost?

$282

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $282 for this service. The price depends on where it is billed: about $275 from a physician practice, and about $2,138 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$275$174 to $316
FacilityA hospital or hospital-owned outpatient department$2,138$1,622 to $3,020

How much rates vary

Facilitymedian $2,138 · 10th to 90th $759 to $4,677Professionalmedian $275 · 10th to 90th $158 to $372
$50$100$200$500$1K$2K$5Kfacility $2,138professional $275

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$309.03
Typical High
$5,754.40
Aetna
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$229.09
Typical High
$316.23
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$85.11
Median
$114.82
Typical High
$154.88
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$34.67
Median
$45.71
Typical High
$63.10
Aetna
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$128.82
Median
$169.82
Typical High
$234.42
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$25.70
Median
$33.88
Typical High
$46.77
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$17.38
Median
$22.91
Typical High
$31.62
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$3,715.35
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$194.98
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$263.03
Typical High
$501.19
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$316.23
Median
$1,905.46
Typical High
$4,897.79
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$316.23
Typical High
$389.05
Health Alliance Plan
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$83.18
Median
$91.20
Typical High
$158.49
Health Alliance Plan
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$33.88
Median
$36.31
Typical High
$63.10
Health Alliance Plan
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$125.89
Median
$138.04
Typical High
$234.42
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$25.12
Median
$27.54
Typical High
$47.86
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$16.60
Median
$18.20
Typical High
$31.62
Priority Health
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$208.93
Typical High
$501.19
United
Setting
Facility
Modifier
None
Typical Low
$660.69
Median
$1,548.82
Typical High
$6,760.83
United
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$234.42
Typical High
$371.54

Where Michigan sits

The same service costs 5.8 times more in Alaska than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Michigan· 29th of 51

$282

AK $955HI $166

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.