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Custom Mould For A Made-To-Measure Breast Implant

New York 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?

$398

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $398 for this service. The price depends on where it is billed: about $263 from a physician practice, and about $4,786 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 9 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$263$182 to $407
FacilityA hospital or hospital-owned outpatient department$4,786$2,138 to $7,586

How much rates vary

Facilitymedian $4,786 · 10th to 90th $240 to $11,220Professionalmedian $263 · 10th to 90th $123 to $759
$100$200$500$1K$2K$5K$10Kfacility $4,786professional $263

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
$177.83
Median
$3,090.30
Typical High
$10,000.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$239.88
Typical High
$758.58
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$5,495.41
Typical High
$12,882.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$288.40
Typical High
$724.44
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$10,964.78
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$223.87
Typical High
$7,762.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$380.19
Typical High
$1,023.29
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$281.84
Typical High
$489.78
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$478.63
Typical High
$602.56
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$346.74
Typical High
$575.44
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$398.11
Typical High
$851.14
United
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$4,897.79
Typical High
$11,220.18
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$295.12
Typical High
$741.31
Univera
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$467.74
Univera
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$323.59
Typical High
$630.96

Where New York 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 York· 10th of 51

$398

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.