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
$301
Median
$49
High
$14.8k
Each hospital's average Regence rate, under the methodology and billing class chosen below.
65 hospitals; the 90th percentile is 3.3× 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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78 hospital rates
iThe hospitals that file a Regence 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 | ALBANY GENERAL HOSPITAL Albany, OR facility · fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 2 | GOOD SAMARITAN HOSPITAL CORVALLIS Corvallis, OR facility · fee schedule · outpatient | 1 | $47 | $47 | — | — | — | $47 – $47 |
| 3 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 4 | GRITMAN MEDICAL CENTER INC Moscow, ID professional · fee schedule · outpatient | 1 | $35 | $35 | — | — | — | $35 – $35 |
| 5 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $51 | $51 | — | — | — | $51 – $51 |
| 6 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $112 | $137 | $59 | 43% | — | $89 – $235 |
| 7 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · percent of total billed charges · bothfrom % of charges | 1 | $36 | $36 | $1 | 2% | — | $35 – $37 |
| 8 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $82 | $100 | $43 | 43% | — | $65 – $172 |
| 9 | IHC Health Services Inc., DBA Intermountain Health American Fork Hospital American Fork, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 10 | IHC Health Services Inc., DBA Intermountain Health Bear River Valley Hospital Tremonton, UT facility · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 11 | IHC Health Services Inc., DBA Intermountain Health Cedar City Hospital Cedar City, UT facility · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 12 | IHC Health Services Inc., DBA Intermountain Health Intermountain Medical Center Murray, UT facility · fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 13 | IHC Health Services Inc., DBA Intermountain Health LDS Hospital Salt Lake City, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 14 | IHC Health Services Inc., DBA Intermountain Health Layton Hospital Layton, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 15 | IHC Health Services Inc., DBA Intermountain Health Logan Regional Hospital Logan, UT facility · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 16 | IHC Health Services Inc., DBA Intermountain Health McKay-Dee Hospital Ogden, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 17 | IHC Health Services Inc., DBA Intermountain Health Orem Community Hospital Orem, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 18 | IHC Health Services Inc., DBA Intermountain Health Park City Hospital Park City, UT facility · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 19 | IHC Health Services Inc., DBA Intermountain Health Riverton Hospital Riverton, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 20 | IHC Health Services Inc., DBA Intermountain Health Spanish Fork Hospital Spanish Fork, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 21 | IHC Health Services Inc., DBA Intermountain Health St George Regional Hospital St. George, UT facility · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 22 | IHC Health Services Inc., DBA Intermountain Health Utah Valley Hospital Provo, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 23 | IHC Health Services, Inc,. DBA Intermountain Health Alta View Hospital Sandy, UT facility · fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 24 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $57 | $76 | $33 | 44% | — | $56 – $147 |
| 25 | MID-VALLEY HEALTHCARE INC Lebanon, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
← Payers reporting HCPCS L8000 · Snapshot 20261111T120946Z-9134e7f7