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South Dakota rates for HCPCS J7316

Injection Ocriplasmin 0.125 Mg (Code Was Deleted01/01/03 But Reinstated On 01/01/14) Sodium Hyaluronate 5 Mg For Intra-Articular Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.20 / $1,185.20 / $1,185.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.72 / $983.72 / $1,007.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.50 / $1,066.50 / $1,333.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.20 / $1,306.94 / $1,761.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.20 / $1,185.20 / $1,303.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,256.09 / $1,306.94 / $1,460.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.18 / $1,256.09 / $2,732.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.20 / $1,185.20 / $1,303.72