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Massachusetts rates for HCPCS 15777

Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.50 / $2,159.00 / $6,707.72
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$744.25 / $9,202.04 / $32,353.62
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.00 / $947.00 / $2,733.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.22 / $314.35 / $6,679.00
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.93 / $4,170.57 / $10,458.87
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,039.10 / $3,445.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00