go back

Wisconsin 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 $2,630 · 10th–90th $380–$8,7100%10%10th90th$2,630Professionalmedian $513 · 10th–90th $316–$7410%20%10th90th$513$1.0$5.0$20.0$100.0$500.0$2.0K$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
$173.78 / $2,884.03 / $10,715.19
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$954.99 / $3,090.30 / $8,912.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,630.27 / $6,165.95
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $234.42 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $616.60 / $1,000.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $616.60 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $691.83 / $2,041.74
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $891.25 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $512.86 / $741.31
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $1,318.26
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,187.76