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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.

Facilitymedian $7,943 · 10th–90th $550$12,0230%10%10th90th$7,943Professionalmedian $282 · 10th–90th $129$8320%5%10%10th90th$282$50.0$200.0$1.0K$5.0K

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
$117.49
Median
$288.40
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$234.42
Typical High
$436.52
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,317.64
Typical High
$13,182.57
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
$724.44
Median
$851.14
Typical High
$1,348.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$416.87
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
Quartz
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$446.68
Typical High
$954.99
Quartz
Setting
Facility
Modifier
Global
Typical Low
$5,888.44
Median
$8,709.64
Typical High
$8,709.64
Quartz
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$691.83
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
$6,606.93
Median
$10,232.93
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$371.54
Typical High
$1,000.00