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Custom Mould For A Made-To-Measure Breast Implant

South Dakota 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?

$324

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $324 for this service. The price depends on where it is billed: about $324 from a physician practice, and about $380 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 7 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$324$234 to $501
FacilityA hospital or hospital-owned outpatient department$380$251 to $3,548

How much rates vary

Facilitymedian $380 · 10th to 90th $170 to $4,365Professionalmedian $324 · 10th to 90th $135 to $631
$200$500$1K$2K$5Kfacility $380professional $324

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$3,548.13
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$234.42
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$446.68
Typical High
$794.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$331.13
Typical High
$741.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$549.54
Typical High
$2,041.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$331.13
Typical High
$660.69
Midlands
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$588.84
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$380.19
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,162.28
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$354.81
Typical High
$741.31
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$288.40
Typical High
$676.08

Where South Dakota 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.

South Dakota· 17th of 51

$324

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.