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Custom Mould For A Made-To-Measure Breast Implant

Minnesota 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 $1,862 · 10th–90th $269$11,4820%5%10%10th90th$1,862Professionalmedian $468 · 10th–90th $224$9550%5%10%10th90th$468$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
$134.90
Median
$269.15
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$213.80
Typical High
$416.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$8,511.38
Typical High
$17,378.01
BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$489.78
Typical High
$933.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$977.24
Typical High
$2,691.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$602.56
Typical High
$1,148.15
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,071.52
Typical High
$2,089.30
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$549.54
Typical High
$1,023.29
Medica
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$371.54
Typical High
$9,332.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$616.60
Typical High
$1,174.90
United
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$6,456.54
Typical High
$10,715.19
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$457.09
Typical High
$933.25