go back

Custom Mould For A Made-To-Measure Breast Implant

Pennsylvania 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?

$251

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $251 for this service. The price depends on where it is billed: about $224 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 9 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$224$129 to $263
FacilityA hospital or hospital-owned outpatient department$4,169$1,778 to $6,607

How much rates vary

Facilitymedian $4,169 · 10th to 90th $661 to $8,318Professionalmedian $224 · 10th to 90th $123 to $447
$100$200$500$1K$2K$5K$10Kfacility $4,169professional $224

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
$660.69
Median
$4,265.80
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$426.58
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$6,456.54
Median
$7,585.78
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$354.81
Typical High
$512.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$446.68
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$501.19
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,584.89
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$288.40
Typical High
$478.63
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$3,890.45
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$239.88
Typical High
$1,412.54
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$316.23
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$1,288.25
Typical High
$2,238.72
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$2,089.30
Median
$4,466.84
Typical High
$11,481.54
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$229.09
Typical High
$446.68

Where Pennsylvania 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.

Pennsylvania· 38th of 51

$251

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.