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
$26
Average
$75
Median
$84
High
$141
Each hospital's average Medica rate, under the methodology and billing class chosen below.
60 hospitals; the 90th percentile is 3.2× 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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86 hospital rates
iThe hospitals that file a Medica 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 | Avera McKennan Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 2 | $86 | $86 | $7 | 8% | 6–60 | $77 – $96 |
| 2 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 4 | $24 | $29 | $14 | 47% | — | $17 – $51 |
| 3 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 4 | $24 | $29 | $14 | 47% | — | $17 – $51 |
| 4 | Avera Behavioral Health Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 2 | $86 | $86 | $7 | 8% | — | $77 – $96 |
| 5 | Avera Specialty Hospital Sioux Falls, SD percent of total billed charges · outpatientfrom % of charges | 2 | $86 | $86 | $7 | 8% | — | $77 – $96 |
| 6 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE other · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 7 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 2 | $59 | $59 | $4 | 6% | — | $55 – $62 |
| 8 | Brookings Health System Brookings, SD fee schedule · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 9 | Brookings Health System Brookings, SD percent of total billed charges · outpatientfrom % of charges | 1 | $80 | $65 | $18 | 27% | — | $43 – $80 |
| 10 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $77 | $94 | $40 | 43% | — | $61 – $161 |
| 11 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $63 | $83 | $36 | 44% | — | $61 – $161 |
| 12 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $95 | $125 | $55 | 44% | — | $92 – $243 |
| 13 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $69 | $91 | $40 | 44% | — | $67 – $176 |
| 14 | Curators of the University of Missouri Jefferson City, MO facility · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 15 | Essentia Health Duluth Duluth, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 16 | Essentia Health Fargo 3000 32nd Ave S Fargo, ND facility · fee schedule · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 17 | Essentia Health St. Joseph's Medical Center Brainerd, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 18 | Essentia Health St. Mary's - Detroit Lakes 1027 Washington Ave. Detroit Lakes, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 19 | Essentia Health St. Mary's Children's Hospital Duluth, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 20 | Essentia Health St. Mary's Medical Center Duluth, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 21 | Essentia Health Virginia 901 9th St N Virginia, MN facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 22 | Fairview Bethesda Hospital St. Paul, MN fee schedule · both | 8 | $102 | $86 | $23 | 27% | — | $50 – $108 |
| 23 | Fairview Bethesda Hospital St. Paul, MN fee schedule · outpatient | 1 | $53 | $53 | — | — | — | $53 – $53 |
| 24 | Fairview Health Services Edina, MN fee schedule · both | 8 | $102 | $86 | $23 | 27% | — | $50 – $108 |
| 25 | Fairview Health Services Edina, MN fee schedule · outpatient | 8 | $116 | $99 | $31 | 31% | — | $53 – $131 |
← Payers reporting HCPCS L8000 · Snapshot 20261111T120946Z-9134e7f7