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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 October 2026.

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

$269

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $269 for this service. The price depends on where it is billed: about $263 from a physician practice, and about $398 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$263$204 to $427
FacilityA hospital or hospital-owned outpatient department$398$219 to $501

How much rates vary

Facilitymedian $398 · 10th to 90th $214 to $2,570Professionalmedian $263 · 10th to 90th $135 to $479
$100$200$500$1K$2K$5Kfacility $398professional $263

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
Professional
Modifier
None
Typical Low
$138.04
Median
$213.80
Typical High
$416.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$2,570.40
Typical High
$7,244.36
Cigna
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$426.58
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$213.80
Median
$269.15
Typical High
$537.03
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$229.09
Typical High
$537.03
Providence
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$2,570.40
Typical High
$7,244.36
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$223.87
Typical High
$446.68
United
Setting
Facility
Modifier
None
Typical Low
$1,479.11
Median
$2,884.03
Typical High
$4,570.88
United
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$363.08
Typical High
$524.81

Where Montana 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.

Montana· 36th of 51

$269

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.