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
$496
Median
$83
High
$14.8k
Each hospital's average Premera rate, under the methodology and billing class chosen below.
37 hospitals; the 90th percentile is 4.1× 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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46 hospital rates
iThe hospitals that file a Premera 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 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 4 | $87 | $89 | $11 | 12% | — | $75 – $106 |
| 2 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $112 | $137 | $59 | 43% | — | $89 – $235 |
| 3 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 1 | $36 | $36 | $1 | 2% | — | $35 – $37 |
| 4 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $82 | $100 | $43 | 43% | — | $65 – $172 |
| 5 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $57 | $76 | $33 | 44% | — | $56 – $147 |
| 6 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 4 | $87 | $89 | $11 | 12% | — | $75 – $106 |
| 7 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $158 | $158 | $4 | 2% | — | $154 – $161 |
| 8 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $41 | $41 | $1 | 2% | — | $41 – $43 |
| 9 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $74 | $97 | $43 | 44% | — | $71 – $189 |
| 10 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $54 | $55 | $1 | 2% | — | $54 – $57 |
| 11 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $41 | $1 | 2% | — | $40 – $42 |
| 12 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · both | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 13 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · outpatient | 1 | $684 | $684 | — | — | — | $684 – $684 |
| 14 | Mount Carmel Grove City Grove City, OH facility · fee schedule · both | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 15 | Mount Carmel Grove City Grove City, OH facility · fee schedule · outpatient | 1 | $684 | $684 | — | — | — | $684 – $684 |
| 16 | Mount Carmel St Ann's Lewis Center, OH facility · fee schedule · both | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 17 | Mount Carmel St Ann's Lewis Center, OH facility · other · outpatient | 1 | $29.4k | $29.4k | — | — | — | $29.4k – $29.4k |
| 18 | MultiCare Auburn Medical Center Auburn, WA fee schedule · outpatient | 4 | $87 | $89 | $11 | 12% | — | $75 – $106 |
| 19 | MultiCare Capital Medical Center Lacey, WA fee schedule · outpatient | 4 | $89 | $86 | $6 | 7% | — | $75 – $89 |
| 20 | MultiCare Covington Medical Center Covington, WA fee schedule · outpatient | 4 | $87 | $89 | $11 | 12% | — | $75 – $106 |
| 21 | MultiCare Deaconess Hospital Spokane, WA fee schedule · outpatient | 4 | $60 | $64 | $6 | 10% | — | $60 – $75 |
| 22 | MultiCare Valley Hospital Spokane Valley, WA fee schedule · outpatient | 4 | $60 | $64 | $6 | 10% | — | $60 – $75 |
| 23 | MultiCare Yakima Valley Memorial Hospital Association Union Gap, WA fee schedule · outpatient | 3 | $75 | $75 | — | — | — | $75 – $75 |
| 24 | Nazareth Hospital Philadelphia, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $158 | $158 | $4 | 2% | — | $154 – $161 |
| 25 | Plymouth Medical Center Plymouth, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $40 | $41 | $1 | 2% | — | $40 – $42 |
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