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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 July 2026.

Professionalmedian $263 · 10th–90th $148$4070%20%10th90th$263$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$309.03
Typical High
$588.84
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$281.84
Typical High
$707.95