go back

Custom Mould For A Made-To-Measure Breast Implant

Wisconsin 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?

$525

Typical negotiated rate. In Wisconsin, July 2026.

Insurers have agreed to pay about $525 for this service. The price depends on where it is billed: about $417 from a physician practice, and about $7,943 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 11 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$417$263 to $631
FacilityA hospital or hospital-owned outpatient department$7,943$5,623 to $10,471

How much rates vary

Facilitymedian $7,943 · 10th to 90th $708 to $12,589Professionalmedian $417 · 10th to 90th $166 to $977
$200$500$1K$2K$5K$10Kfacility $7,943professional $417

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
$117.49
Median
$288.40
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$269.15
Typical High
$870.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,317.64
Typical High
$13,489.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$446.68
Typical High
$1,000.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$831.76
Typical High
$1,348.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$389.05
Typical High
$812.83
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$549.54
Typical High
$6,918.31
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$467.74
Typical High
$794.33
Medica
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$3,981.07
Typical High
$11,481.54
Medica
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$524.81
Typical High
$1,202.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$371.54
Network Health
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$8,511.38
Typical High
$9,120.11
Network Health
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$630.96
Typical High
$812.83
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$234.42
Typical High
$524.81
Quartz
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$446.68
Typical High
$954.99
Quartz
Setting
Facility
Modifier
Global
Typical Low
$6,165.95
Median
$8,912.51
Typical High
$8,912.51
Quartz
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$489.78
Typical High
$2,137.96
Security Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$524.81
Security Health
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$588.84
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$4,265.80
Median
$10,232.93
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$363.08
Typical High
$977.24

Where Wisconsin 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.

Wisconsin· 4th of 51

$525

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.