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Custom Mould For A Made-To-Measure Breast Implant

Ohio 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?

$240

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $240 for this service. The price depends on where it is billed: about $200 from a physician practice, and about $4,169 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 8 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$200$138 to $302
FacilityA hospital or hospital-owned outpatient department$4,169$912 to $7,586

How much rates vary

Facilitymedian $4,169 · 10th to 90th $229 to $10,965Professionalmedian $200 · 10th to 90th $123 to $676
$50$200$1K$5Kfacility $4,169professional $200

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
$229.09
Median
$4,168.69
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$229.09
Typical High
$7,413.10
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,715.35
Typical High
$15,135.61
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$162.18
Typical High
$346.74
CareSource
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$141.25
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$223.87
Typical High
$21,379.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$281.84
Typical High
$489.78
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$21,379.62
Median
$21,379.62
Typical High
$21,379.62
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$281.84
Typical High
$489.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$288.40
Typical High
$549.54
United
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$5,495.41
Typical High
$9,120.11
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$229.09
Typical High
$446.68

Where Ohio 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.

Ohio· 44th of 51

$240

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.