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Custom Mould For A Made-To-Measure Breast Implant

Oklahoma 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?

$1,000

Typical negotiated rate. In Oklahoma, July 2026.

Insurers have agreed to pay about $1,000 for this service. The price depends on where it is billed: about $257 from a physician practice, and about $1,622 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 4 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$257$151 to $295
FacilityA hospital or hospital-owned outpatient department$1,622$1,000 to $4,467

How much rates vary

Facilitymedian $1,622 · 10th to 90th $275 to $6,761Professionalmedian $257 · 10th to 90th $141 to $468
$200$500$1K$2K$5K$10Kfacility $1,622professional $257

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
$275.42
Median
$1,513.56
Typical High
$6,606.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$275.42
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$229.09
Typical High
$389.05
Medica
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$645.65
Typical High
$6,165.95
Medica
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$323.59
Typical High
$2,041.74
United
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$3,981.07
Typical High
$8,317.64
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$354.81

Where Oklahoma 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.

Oklahoma· 2nd of 51

$1,000

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.