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Custom Mould For A Made-To-Measure Breast Implant

Texas 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 $2,570 · 10th–90th $178$8,5110%5%10%10th90th$2,570Professionalmedian $229 · 10th–90th $126$4170%10%10th90th$229$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
$660.69
Median
$3,235.94
Typical High
$11,481.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$223.87
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$239.88
Typical High
$389.05
Christus
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$288.40
Typical High
$489.78
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$257.04
Typical High
$489.78
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$323.59
Typical High
$524.81
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$489.78
Typical High
$1,096.48
Providence
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$257.04
Typical High
$489.78
Providence
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$295.12
Typical High
$501.19
United
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$4,466.84
Typical High
$9,549.93
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$223.87
Typical High
$398.11
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$281.84
Typical High
$389.05