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Custom Mould For A Made-To-Measure Breast Implant

Nebraska 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 $7,413 · 10th–90th $479$14,4540%10%10th90th$7,413Professionalmedian $316 · 10th–90th $129$1,5140%10%20%10th90th$316$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
$5,754.40
Median
$8,511.38
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$251.19
Typical High
$1,548.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$3,162.28
Typical High
$6,165.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$263.03
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$501.19
Typical High
$794.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$380.19
Typical High
$6,309.57
Medica
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$575.44
Typical High
$2,041.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$588.84
Typical High
$831.76
Midlands
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$5,128.61
Typical High
$7,585.78
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$338.84
Typical High
$660.69