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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.

Facilitymedian $380 · 10th–90th $170$4,3650%10%10th90th$380Professionalmedian $324 · 10th–90th $135$6310%10%10th90th$324$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

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