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Custom Mould For A Made-To-Measure Breast Implant

Virginia 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 $3,388 · 10th–90th $162$9,5500%5%10th90th$3,388Professionalmedian $251 · 10th–90th $138$5130%10%10th90th$251$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
$245.47
Median
$4,365.16
Typical High
$8,912.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$251.19
Typical High
$436.52
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,888.44
Median
$6,760.83
Typical High
$7,413.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$263.03
Typical High
$436.52
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$194.98
Typical High
$954.99
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$251.19
Typical High
$478.63
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$338.84
Typical High
$912.01
Medcost
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$263.03
Typical High
$676.08
Medcost
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$263.03
Typical High
$467.74
Sentara
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$190.55
Typical High
$10,000.00
Sentara
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$371.54
Typical High
$10,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$5,623.41
Median
$8,709.64
Typical High
$17,782.79
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$229.09
Typical High
$457.09