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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.

How much does Custom Mould For A Made-To-Measure Breast Implant cost?

$282

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $282 for this service. The price depends on where it is billed: about $251 from a physician practice, and about $3,388 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 8 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$162 to $324
FacilityA hospital or hospital-owned outpatient department$3,388$240 to $7,079

How much rates vary

Facilitymedian $3,388 · 10th to 90th $162 to $9,550Professionalmedian $251 · 10th to 90th $138 to $513
$100$200$500$1K$2K$5K$10Kfacility $3,388professional $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
$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

Where Virginia 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.

Virginia· 26th of 51

$282

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.