Mastectomy bra

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

Tricare pricing summary

Low

$11

Average

$58

Median

$49

High

$188

Tricare rate distribution

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61 hospital rates

#		Plans
1	Abington Memorial Hospital Abington, PA facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
2	Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · both	1	$47	$47	—	—	—	$47 – $47
3	Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient	1	$53	$53	—	—	—	$53 – $53
4	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient	1	$44	$44	—	—	—	$44 – $44
5	CORNING HOSPITAL Corning, NY facility · other · outpatient	2	$61	$61	—	—	—	$61 – $61
6	Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient	1	$41	$41	—	—	—	$41 – $41
7	Central Maine Medical Center Lewiston, ME fee schedule · outpatient	1	$46	$46	—	—	—	$46 – $46
8	Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges	1	$180	$188	$12	7%	—	$167 – $203
9	Clarion Hospital Clarion, PA facility · fee schedule · outpatient	1	$44	$44	—	—	—	$44 – $44
10	Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
11	FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient	1	$54	$54	—	—	—	$54 – $54
12	FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient	1	$54	$54	—	—	—	$54 – $54
13	GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient	1	$61	$61	—	—	—	$61 – $61
14	Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges	1	$113	$138	$59	43%	—	$90 – $237
15	Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges	1	$83	$101	$43	43%	—	$66 – $173
16	IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
17	IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
18	Jefferson Health - Northeast Langhorne, PA facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
19	Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
20	Jefferson Health - Northeast Philadelphia, PA facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
21	Kennedy University Hospital, Inc Turnersville, NJ facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
22	Kennedy University Hospital, Inc Cherry Hill, NJ facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
23	Lansdale Hospital Corp Lansdale, PA facility · fee schedule · outpatient	1	$45	$45	—	—	—	$45 – $45
24	Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient	1	$50	$50	—	—	—	$50 – $50
25	MCLAREN BAY REGION CITY, MI fee schedule	1	$50	$50	—	—	—	$50 – $50

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HCPCS L8000