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Custom Mould For A Made-To-Measure Breast Implant

Oregon 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 $525 · 10th–90th $251$9,3330%20%10th90th$525Professionalmedian $417 · 10th–90th $200$7590%10%10th90th$417$100.0$500.0$2.0K$10.0K$50.0K$200.0K$1.0M

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
$354.81
Median
$707.95
Typical High
$17,378.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$416.87
Typical High
$870.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$380.19
Typical High
$741.31
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$371.54
Typical High
$707.95
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$331.13
Typical High
$588.84
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$436.52
Typical High
$676.08
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$524.81
Typical High
$562.34
Providence
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$338.84
Typical High
$645.65
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$363.08
Typical High
$691.83
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$9,120.11
Median
$12,589.25
Typical High
$15,135.61
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$489.78
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$4,073.80
Median
$11,748.98
Typical High
$25,118.86
United
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$389.05
Typical High
$724.44