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Custom Mould For A Made-To-Measure Breast Implant

Wyoming 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 $7,943 · 10th–90th $4,169$14,7910%20%40%10th90th$7,943Professionalmedian $427 · 10th–90th $331$6760%20%40%10th90th$427$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$281.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$426.58
Typical High
$676.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$338.84
Typical High
$676.08
United
Setting
Facility
Modifier
Global
Typical Low
$4,168.69
Median
$7,943.28
Typical High
$14,791.08
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$331.13
Typical High
$660.69