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Washington 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 $1,514 · 10th–90th $282–$10,2330%5%10th90th$1,514$200.0$500.0$1.0K$2.0K$5.0K$10.0K$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
$281.84 / $3,548.13 / $14,791.08
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$660.69 / $794.33 / $8,511.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,235.94 / $3,235.94
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$4,897.79 / $4,897.79 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $1,122.02
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $426.58 / $537.03
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $4,265.80
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $407.38 / $426.58
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $3,235.94
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$3,890.45 / $3,890.45 / $4,897.79
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $645.65 / $5,754.40