We're dealing with reasonably sophisticated state actors here in this dark forest; not script kiddies.
Cheap $5 PCB + programmable small FPGA is a very viable route too for hardware implants; but even a microcontroller / ESP32/etc will probably do.
Cellular communications hardware seems very sophisticated and expensive compared to a simple microcontroller.
Eg. https://dangerousthings.com/products/apex-flex?Antenna=Narro...
They did, in fact, appear to mass-manufacture a custom-built flat flex implant with cellular (LTE-M!), eSIM, and everything that hid right inside the Ledger, sniffing the SPI reads to the display to read the recovery phrases it pukes out and send 'em over cellular to the ringleader.
It's an EXTREMELY well built implant. I'm impressed. Multiple revisions, even.
The money's too hot to not build shit like this and slip it into the stream. Even a few thousand in R&D netting a six figure ROI is worth it, getting millions is just the icing.
But yeah, putting a cellular modem and eSIM on there is certainly taking it to the next level