go back

Custom Mould For A Made-To-Measure Breast Implant

Washington 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 $646 · 10th–90th $269$14,4540%10%10th90th$646Professionalmedian $355 · 10th–90th $151$7590%10%20%10th90th$355$10.0$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
$288.40
Median
$776.25
Typical High
$17,782.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$269.15
Typical High
$758.58
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$7,079.46
Median
$11,748.98
Typical High
$20,892.96
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$380.19
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$3,630.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$389.05
Typical High
$758.58
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$446.68
Typical High
$4,168.69
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$398.11
Typical High
$891.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$60.26
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$524.81
Typical High
$562.34
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$371.54
Typical High
$676.08
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$7,079.46
Median
$11,481.54
Typical High
$20,892.96
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$380.19
Typical High
$676.08
United
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$12,302.69
Typical High
$22,387.21
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$354.81
Typical High
$707.95
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$263.03
Typical High
$426.58