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
$28
Average
$131
Median
$74
High
$3.1k
Each hospital's average Medical Mutual rate, under the methodology and billing class chosen below.
56 hospitals; the 90th percentile is 2.3× 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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63 hospital rates
iThe hospitals that file a Medical Mutual 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 | St Joseph Mercy Ann Arbor Ypsilanti, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $65 | $74 | $18 | 24% | 5–50 | $64 – $110 |
| 2 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 3 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 4 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $53 | $53 | — | — | — | $53 – $53 |
| 5 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 6 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $41 | $50 | $22 | 43% | — | $33 – $86 |
| 7 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $34 | $44 | $19 | 44% | — | $33 – $86 |
| 8 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $71 | $94 | $41 | 44% | — | $69 – $183 |
| 9 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $86 | $114 | $50 | 44% | — | $84 – $222 |
| 10 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $85 | $86 | $2 | 2% | — | $85 – $89 |
| 11 | Fisher-Titus Medical Center Norwalk, OH facility · fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 12 | GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 13 | JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 14 | McCullough-Hyde Memorial Hospital, Inc. Oxford, OH facility · fee schedule · outpatient | 1 | $53 | $53 | — | — | — | $53 – $53 |
| 15 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $66 | $67 | $1 | 2% | — | $66 – $69 |
| 16 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $77 | $102 | $45 | 44% | — | $75 – $198 |
| 17 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $70 | $71 | $2 | 2% | — | $70 – $74 |
| 18 | Mercy Health Services-Iowa Corp. Mason City, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $51 | $67 | $29 | 44% | — | $49 – $130 |
| 19 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $87 | $88 | $2 | 2% | — | $86 – $91 |
| 20 | Mercy Medical Center - Dubuque Dubuque, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $81 | $107 | $47 | 44% | — | $78 – $207 |
| 21 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $80 | $106 | $46 | 44% | — | $77 – $205 |
| 22 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $108 | $138 | $50 | 37% | — | $105 – $244 |
| 23 | Mercy Medical Center - Newton Newton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $91 | $120 | $52 | 44% | — | $88 – $233 |
| 24 | Mercy Medical Center-Clinton Inc Clinton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $85 | $112 | $49 | 44% | — | $82 – $217 |
| 25 | Metrohealth System Parma, OH facility · fee schedule · outpatient | 2 | $33 | $33 | $5 | 14% | — | $28 – $38 |
← Payers reporting HCPCS L8000 · Snapshot 20261111T120946Z-9134e7f7