Mastectomy bra with built-in breast form at Fairview Maple Grove Surgery Center

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Breast prosthesis bra & form

Maple Grove, MN

See all hospitals reporting HCPCS L8001 →

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $170 is 7% above the median hospital's median price ($158), higher than 73% of the 881 hospitals reporting HCPCS L8001. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L8001 at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 5 payers, 22 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Blue Cross Blue Shield federal fee schedule · outpatient	$130	$130	—	—	—	$130 – $130
2	Blue Cross Blue Shield commercial fee schedule · outpatient	$132	$132	—	—	—	$132 – $132
3	Blue Cross Blue Shield medicaid fee schedule · outpatient	$132	$132	—	—	—	$132 – $132
4	Blue Cross Blue Shield federal fee schedule · both	$141	$141	—	—	—	$141 – $141
5	Blue Cross Blue Shield commercial fee schedule · both	$143	$143	—	—	—	$143 – $143
6	Medica accessability fee schedule · both	$148	$148	—	—	—	$148 – $148
7	Medica medicaid fee schedule · both	$148	$148	—	—	—	$148 – $148
8	Medica ma non-snp fee schedule · both	$161	$161	—	—	—	$161 – $161
9	Medica ma snp fee schedule · both	$161	$161	—	—	—	$161 – $161
10	Medica prime solution fee schedule · both	$161	$161	—	—	—	$161 – $161
11	Medica vantage fee schedule · both	$161	$161	—	—	—	$161 – $161
12	Blue Cross Blue Shield medicaid fee schedule · both	$161	$161	—	—	—	$161 – $161
13	Ucare mhcp fee schedule · both	$165	$165	—	—	—	$165 – $165
14	Cigna commercial fee schedule · both	$198	$198	$17	9%	—	$181 – $216
15	Ucare ifp with fairview fee schedule · outpatient	$266	$266	—	—	—	$266 – $266
16	Medica bold fee schedule · both	$279	$279	—	—	—	$279 – $279
17	UnitedHealthcare commercial fee schedule · both	$290	$290	—	—	—	$290 – $290
18	Medica choice without / elect fee schedule · both	$310	$310	—	—	—	$310 – $310
19	Medica city of st paul / essential uplan fee schedule · both	$310	$310	—	—	—	$310 – $310
20	Medica choice with fee schedule · both	$321	$321	—	—	—	$321 – $321
21	Ucare ifp fee schedule · outpatient	$355	$355	—	—	—	$355 – $355
22	Cigna commercial fee schedule · outpatient	$417	$417	$36	9%	—	$380 – $453

Last updated: May 18, 2026

Compare to other hospitals

See Mastectomy bra with built-in breast form pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.