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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.

Facilitymedian $1,622 · 10th–90th $275$6,7610%5%10th90th$1,622Professionalmedian $257 · 10th–90th $141$4680%10%20%10th90th$257$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$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