go back

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.

Facilitymedian $4,169 · 10th–90th $229$10,9650%10%10th90th$4,169Professionalmedian $200 · 10th–90th $123$6760%10%20%10th90th$200$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$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