Mastectomy bra with built-in breast forms, both sides at St Luke's Methodist Hospital

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

Brst prsth bra & bilat form

Cedar Rapids, IA

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How this price compares nationally

St Luke's Methodist Hospital’s median price of $208 is about the same as the median hospital's median price ($208), higher than 50% of the 863 hospitals reporting HCPCS L8002. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L8002 at St Luke's Methodist Hospital

Negotiated rates from the hospital’s own file: 6 payers, 17 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	UnitedHealthcare hmo fee schedule · both	$99	$99	—	—	—	$99 – $99
2	UnitedHealthcare ppo fee schedule · both	$99	$99	—	—	—	$99 – $99
3	Wellmark commercial fee schedule · both	$194	$194	—	—	—	$194 – $194
4	Wellmark hmo fee schedule · both	$194	$194	—	—	—	$194 – $194
5	Wellmark ppo fee schedule · both	$194	$194	—	—	—	$194 – $194
6	Aetna medicare advantage case rate · outpatient	$202	$202	—	—	—	$202 – $202
7	Molina medicare advantage case rate · outpatient	$202	$202	—	—	—	$202 – $202
8	Wellmark medicare advantage case rate · outpatient	$202	$202	—	—	—	$202 – $202
9	Humana medicare advantage case rate · outpatient	$208	$208	—	—	—	$208 – $208
10	UnitedHealthcare medicare advantage case rate · outpatient	$208	$208	—	—	—	$208 – $208
11	Aetna hmo fee schedule · both	$222	$222	—	—	—	$222 – $222
12	Aetna ppo fee schedule · both	$222	$222	—	—	—	$222 – $222
13	Cigna commercial fee schedule · both	$252	$252	—	—	—	$252 – $252
14	UnitedHealthcare hmo fee schedule · outpatient	$285	$285	—	—	—	$285 – $285
15	UnitedHealthcare ppo fee schedule · outpatient	$285	$285	—	—	—	$285 – $285
16	Aetna hmo fee schedule · outpatient	$367	$367	—	—	—	$367 – $367
17	Aetna ppo fee schedule · outpatient	$367	$367	—	—	—	$367 – $367

Last updated: Jan 28, 2026

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