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Custom Mould For A Made-To-Measure Breast Implant

North Carolina 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 $138$8,7100%5%10%10th90th$447Professionalmedian $269 · 10th–90th $138$5370%10%10th90th$269$100.0$500.0$2.0K$10.0K

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
$186.21
Median
$1,000.00
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$269.15
Typical High
$524.81
BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$707.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$288.40
Typical High
$575.44
Medcost
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$251.19
Typical High
$436.52
Medcost
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$3,388.44
Median
$8,912.51
Typical High
$16,982.44
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$229.09
Typical High
$524.81
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$8,912.51
Typical High
$8,912.51
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,290.87