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Custom Mould For A Made-To-Measure Breast Implant

New Mexico 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 $457 · 10th–90th $200$9,5500%5%10%10th90th$457Professionalmedian $214 · 10th–90th $107$7590%10%10th90th$214$50.0$200.0$1.0K$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
$199.53
Median
$457.09
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$213.80
Typical High
$758.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$269.15
Typical High
$478.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$380.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$269.15
Typical High
$588.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$275.42
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$9,549.93
Typical High
$16,982.44
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$251.19
Typical High
$501.19