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Custom Mould For A Made-To-Measure Breast Implant

Vermont 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 October 2026.

How much does Custom Mould For A Made-To-Measure Breast Implant cost?

$263

Typical physician fee. In Vermont, October 2026.

Insurers have agreed to pay about $263 for this service. Most negotiated rates run $214 to $468.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,188 · 10th to 90th $468 to $3,548Professionalmedian $263 · 10th to 90th $148 to $575
$200$500$1K$2Kfacility $2,188professional $263

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$263.03
Cigna
Setting
Facility
Modifier
None
Typical Low
$467.74
Median
$467.74
Typical High
$3,548.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$309.03
Typical High
$501.19
United
Setting
Facility
Modifier
None
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
United
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$275.42
Typical High
$616.60

Where Vermont sits

The same service costs 5.8 times more in Alaska than in Hawaii. 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.

Vermont· 38th of 51

$263

AK $955HI $166

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.