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Custom Mould For A Made-To-Measure Breast Implant

South Carolina 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 $7,943 · 10th–90th $162$20,4170%10%10th90th$7,943Professionalmedian $224 · 10th–90th $138$3800%20%10th90th$224$50.0$200.0$1.0K$5.0K$20.0K

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
$154.88
Median
$9,772.37
Typical High
$21,877.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$223.87
Typical High
$380.19
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$8,912.51
Typical High
$14,791.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$251.19
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$275.42
Typical High
$524.81
Medcost
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$281.84
Typical High
$588.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$12,589.25
Typical High
$22,387.21
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$407.38