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Custom Mould For A Made-To-Measure Breast Implant

Montana 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 $447 · 10th–90th $245$5890%20%10th90th$447Professionalmedian $302 · 10th–90th $138$1,0960%10%20%10th90th$302$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
Professional
Modifier
Global
Typical Low
$138.04
Median
$269.15
Typical High
$1,548.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$223.87
Typical High
$478.63
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$467.74
Typical High
$501.19
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$467.74
Typical High
$501.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$223.87
Typical High
$446.68
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$223.87
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$346.74
Typical High
$575.44