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
$29
Average
$516
Median
$77
High
$14.8k
Each hospital's average Excellus rate, under the methodology and billing class chosen below.
36 hospitals; the 90th percentile is 4.8× 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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45 hospital rates
iThe hospitals that file a Excellus 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 | MVHS, Inc. Utica, NY percent of total billed charges · bothfrom % of charges | 3 | $46 | $67 | $33 | 49% | 5–50 | $38 – $119 |
| 2 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $182 | $182 | — | — | — | $182 – $182 |
| 3 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 2 | $75 | $75 | $29 | 39% | — | $45 – $104 |
| 4 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $112 | $137 | $59 | 43% | — | $89 – $235 |
| 5 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 1 | $36 | $36 | $1 | 2% | — | $35 – $37 |
| 6 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $82 | $100 | $43 | 43% | — | $65 – $172 |
| 7 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $57 | $76 | $33 | 44% | — | $56 – $147 |
| 8 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $158 | $158 | $4 | 2% | — | $154 – $161 |
| 9 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $41 | $41 | $1 | 2% | — | $41 – $43 |
| 10 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $74 | $97 | $43 | 44% | — | $71 – $189 |
| 11 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $54 | $55 | $1 | 2% | — | $54 – $57 |
| 12 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $41 | $1 | 2% | — | $40 – $42 |
| 13 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · both | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 14 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · outpatient | 1 | $684 | $684 | — | — | — | $684 – $684 |
| 15 | Mount Carmel Grove City Grove City, OH facility · fee schedule · both | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 16 | Mount Carmel Grove City Grove City, OH facility · fee schedule · outpatient | 1 | $684 | $684 | — | — | — | $684 – $684 |
| 17 | Mount Carmel St Ann's Lewis Center, OH facility · fee schedule · both | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 18 | Mount Carmel St Ann's Lewis Center, OH facility · other · outpatient | 1 | $29.4k | $29.4k | — | — | — | $29.4k – $29.4k |
| 19 | Nazareth Hospital Philadelphia, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $158 | $158 | $4 | 2% | — | $154 – $161 |
| 20 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $94 | $94 | — | — | — | $94 – $94 |
| 21 | Plymouth Medical Center Plymouth, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $41 | $1 | 2% | — | $40 – $42 |
| 22 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 2 | $63 | $63 | $21 | 33% | — | $41 – $87 |
| 23 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $67 | $68 | $1 | 2% | — | $67 – $70 |
| 24 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $29 | $38 | $17 | 44% | — | $28 – $74 |
| 25 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · fee schedule · both | 1 | $76 | $76 | — | — | — | $76 – $76 |
← Payers reporting HCPCS L8000 · Snapshot 20261111T120946Z-9134e7f7