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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.

Facilitymedian $3,802 · 10th–90th $468$10,0000%10%10th90th$3,802Professionalmedian $288 · 10th–90th $138$6170%5%10th90th$288$100.0$200.0$500.0$1.0K$2.0K$5.0K$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
$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