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Pennsylvania 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 $3,020 · 10th–90th $372–$9,3330%5%10%10th90th$3,020$50.0$200.0$1.0K$5.0K$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
$338.84 / $2,691.53 / $9,332.54
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$1,023.29 / $6,025.60 / $15,488.17
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,890.45 / $20,892.96
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,466.84 / $57,543.99
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $588.84 / $9,120.11
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$602.56 / $3,981.07 / $6,760.83
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,162.28 / $19,952.62
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $1,584.89 / $6,165.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $630.96 / $4,466.84