Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Generation details were not recorded for this description.
Original text from hospital filings
BREAST PROSTHESIS, MASTECTOMY BRA, WITHOUT INTEGRATED BREAST PROSTHESIS FORM, ANY SIZE, ANY TYPE
Low
$1
Average
$107
Median
$55
High
$14.8k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
503 hospitals; the 90th percentile is 3.1× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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636 hospital rates
iThe hospitals that file a Blue Cross Blue Shield rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Inspira Medical Center Vineland Vineland, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $30 | $34 | $5 | 15% | 145–1,450 | $30 – $49 |
| 2 | Self Regional Healthcare Greenwood, SC facility · other · outpatient | 1 | $224 | $224 | — | — | 55–550 | $224 – $224 |
| 3 | St Joseph Mercy Ann Arbor Ypsilanti, MI facility · percent of total billed charges · bothfrom % of charges | 3 | $30 | $30 | $3 | 9% | 52–196 | $19 – $32 |
| 4 | St Mary Mercy Livonia Livonia, MI facility · percent of total billed charges · bothfrom % of charges | 3 | $34 | $34 | $3 | 8% | 41–113 | $22 – $36 |
| 5 | DIGNITY COMMUNITY CARE Chandler, AZ fee schedule · outpatient | 4 | $177 | $197 | $54 | 28% | 33 | $152 – $301 |
| 6 | Inspira Medical Center Mullica Hill Hill, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $30 | $34 | $5 | 15% | 29–290 | $30 – $49 |
| 7 | DIGNITY HEALTH Gilbert, AZ fee schedule · outpatient | 4 | $177 | $197 | $54 | 28% | 17 | $152 – $301 |
| 8 | West Virginia University Hospitals, Inc. Morgantown, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $173 | $173 | — | — | 16 | $173 – $173 |
| 9 | DIGNITY HEALTH Phoenix, AZ fee schedule · outpatient | 4 | $205 | $199 | $61 | 31% | 5–50 | $120 – $360 |
| 10 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $82 | $100 | $43 | 43% | 4–40 | $65 – $172 |
| 11 | City Hospital, Inc. Martinsburg, WV facility · percent of total billed charges · outpatientfrom % of charges | 1 | $251 | $251 | — | — | 2–20 | $251 – $251 |
| 12 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 13 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · bothfrom % of charges | 3 | $45 | $43 | $7 | 16% | — | $29 – $58 |
| 14 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · inpatientfrom % of charges | 2 | $43 | $42 | $7 | 16% | — | $29 – $57 |
| 15 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 7 | $43 | $43 | $8 | 20% | — | $29 – $74 |
| 16 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 17 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 5 | $46 | $48 | $31 | 63% | — | $4 – $148 |
| 18 | ANGEL MEDICAL CENTER Franklin, NC percent of total billed charges · outpatientfrom % of charges | 6 | $56 | $46 | $15 | 32% | — | $24 – $56 |
| 19 | ATHOL MEMORIAL HOSPITAL INCORPORATED Athol, MA fee schedule · outpatient | 3 | $51 | $51 | $1 | 2% | — | $49 – $51 |
| 20 | AdventHealth Orlando Winter Park, FL fee schedule · outpatient | 2 | $55 | $55 | $1 | 1% | — | $54 – $55 |
| 21 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · fee schedule · outpatient | 2 | $169 | $168 | $9 | 5% | — | $156 – $178 |
| 22 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · fee schedule · outpatient | 2 | $171 | $170 | $9 | 5% | — | $158 – $180 |
| 23 | Advocate Christ Medical Center Oak Lawn, IL facility · fee schedule · outpatient | 2 | $166 | $165 | $9 | 5% | — | $153 – $175 |
| 24 | Advocate Condell Medical Center Libertyville, IL fee schedule · outpatient | 2 | $105 | $104 | $5 | 5% | — | $97 – $110 |
| 25 | Advocate Good Samaritan Hospital Downers Grove, IL fee schedule · outpatient | 2 | $170 | $168 | $9 | 5% | — | $157 – $179 |
← Payers reporting HCPCS L8000 · Snapshot 20261111T120946Z-9134e7f7