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Custom Mould For A Made-To-Measure Breast Implant

West 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?

$214

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $214 for this service. The price depends on where it is billed: about $209 from a physician practice, and about $251 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 4 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$209$145 to $288
FacilityA hospital or hospital-owned outpatient department$251$135 to $251

How much rates vary

Facilitymedian $251 · 10th to 90th $135 to $1,738Professionalmedian $209 · 10th to 90th $123 to $324
$50$200$1K$5Kfacility $251professional $209

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
$134.90
Median
$251.19
Typical High
$1,412.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$323.59
CareSource
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$181.97
CareSource
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$223.87
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$275.42
Typical High
$2,137.96
United
Setting
Facility
Modifier
Global
Typical Low
$2,884.03
Median
$3,235.94
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$199.53
Typical High
$346.74

Where West 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.

West Virginia· 51st of 51

$214

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.