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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.

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

$363

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $363 for this service. The price depends on where it is billed: about $302 from a physician practice, and about $447 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$302$245 to $490
FacilityA hospital or hospital-owned outpatient department$447$245 to $479

How much rates vary

Facilitymedian $447 · 10th to 90th $245 to $589Professionalmedian $302 · 10th to 90th $138 to $1,096
$100$1K$10K$100Kfacility $447professional $302

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Montana sits

The same service costs 21.4 times more in California than in West Virginia. 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· 14th of 51

$363

CA $4,571WV $214

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.