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Custom Mould For A Made-To-Measure Breast Implant

New Hampshire 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?

$295

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $295 for this service. The price depends on where it is billed: about $288 from a physician practice, and about $3,802 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 5 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$288$209 to $447
FacilityA hospital or hospital-owned outpatient department$3,802$776 to $6,310

How much rates vary

Facilitymedian $3,802 · 10th to 90th $468 to $10,000Professionalmedian $288 · 10th to 90th $138 to $617
$100$200$500$1K$2K$5K$10Kfacility $3,802professional $288

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
Facility
Modifier
Global
Typical Low
$467.74
Median
$776.25
Typical High
$11,481.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$218.78
Typical High
$251.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$4,677.35
Typical High
$6,309.57
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$281.84
Typical High
$512.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$380.19
Typical High
$758.58
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$10,000.00
Median
$10,000.00
Typical High
$10,000.00
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$346.74
Typical High
$724.44
United
Setting
Facility
Modifier
Global
Typical Low
$10,000.00
Median
$10,000.00
Typical High
$10,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$346.74
Typical High
$758.58

Where New Hampshire 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.

New Hampshire· 22nd of 51

$295

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.