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Custom Mould For A Made-To-Measure Breast Implant

Utah 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?

$257

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $257 for this service. The price depends on where it is billed: about $251 from a physician practice, and about $4,571 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$251$182 to $389
FacilityA hospital or hospital-owned outpatient department$4,571$3,162 to $7,762

How much rates vary

Facilitymedian $4,571 · 10th to 90th $145 to $8,913Professionalmedian $251 · 10th to 90th $135 to $490
$50$200$1K$5Kfacility $4,571professional $251

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. 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
$4,570.88
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$251.19
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$269.15
Typical High
$478.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$338.84
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$5,495.41
Median
$7,585.78
Typical High
$11,481.54
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$275.42
Typical High
$478.63
Select Health
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Select Health
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$512.86
Typical High
$602.56
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$363.08
Typical High
$512.86
United
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$5,128.61
Typical High
$8,317.64
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$257.04
Typical High
$501.19

Where Utah 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.

Utah· 35th of 51

$257

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.