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Custom Mould For A Made-To-Measure Breast Implant

New Jersey 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 $6,918 · 10th–90th $513$11,7490%10%10th90th$6,918Professionalmedian $240 · 10th–90th $120$6460%10%10th90th$240$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
$512.86
Median
$6,918.31
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$223.87
Typical High
$5,888.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$281.84
Typical High
$676.08
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$346.74
Typical High
$549.54
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$7,762.47
Median
$12,302.69
Typical High
$20,417.38
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$288.40
Typical High
$562.34
United
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$7,413.10
Typical High
$15,135.61
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$208.93
Typical High
$501.19