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Utah 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 $3,981 · 10th–90th $2,239–$7,5860%10%10th90th$3,981Professionalmedian $302 · 10th–90th $200–$4790%10%20%10th90th$302$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$1,348.96 / $3,388.44 / $7,762.47
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$3,235.94 / $6,918.31 / $6,918.31
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $302.00 / $478.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61