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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.66 / $2,747.00 / $9,348.75
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,366.40 / $4,198.27 / $15,492.63
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,298.89 / $3,041.12 / $41,934.37
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.33 / $3,433.04 / $6,554.00
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$604.75 / $604.75 / $3,958.91
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,931.66 / $3,001.19 / $27,590.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.25 / $2,326.00 / $9,153.31
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,015.00 / $6,024.83 / $15,492.63
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.11 / $242.11 / $242.11
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.96 / $209.05 / $209.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $674.00 / $4,300.00