go back

Custom Mould For A Made-To-Measure Breast Implant

North Dakota 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 $269 · 10th–90th $135$5,8880%20%10th90th$269Professionalmedian $331 · 10th–90th $145$6310%10%10th90th$331$200.0$500.0$1.0K$2.0K$5.0K

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
$5,011.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$269.15
Typical High
$288.40
BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$398.11
Typical High
$660.69
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$354.81
Typical High
$831.76
Medica
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$288.40
Typical High
$489.78
Medica
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$524.81
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$5,888.44
Typical High
$5,888.44
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$316.23
Typical High
$660.69