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Ohio 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)

Facilitymedian $2,089 · 10th–90th $513–$9,1200%10%10th90th$2,089$0.2$2.0$20.0$200.0$2.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $2,041.74 / $9,120.11
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$891.25 / $2,951.21 / $9,772.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,137.96 / $2,511.89
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $263.03 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.19 / $3,311.31 / $26,915.35
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $1,071.52 / $4,786.30