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.

Facilitymedian $4,169 · 10th–90th $661$8,3180%5%10%10th90th$4,169Professionalmedian $224 · 10th–90th $123$4470%10%10th90th$224$100.0$500.0$2.0K$10.0K$50.0K

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
$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