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Custom Mould For A Made-To-Measure Breast Implant

Tennessee 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 $3,090 · 10th–90th $708$6,7610%10%10th90th$3,090Professionalmedian $229 · 10th–90th $123$5250%5%10%10th90th$229$100.0$500.0$2.0K$10.0K

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
$524.81
Median
$2,398.83
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$223.87
Typical High
$331.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$4,073.80
Typical High
$5,888.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$302.00
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$489.78
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$8,912.51
Typical High
$8,912.51
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,290.87
Typical High
$2,290.87
United
Setting
Facility
Modifier
Global
Typical Low
$2,754.23
Median
$4,466.84
Typical High
$7,585.78
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$269.15
Typical High
$524.81