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Wisconsin 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
$1,570.40 / $2,093.86 / $2,093.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.03 / $2,742.96 / $2,742.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,936.82 / $2,250.90 / $2,334.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.42 / $1,007.42 / $1,486.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,046.93 / $2,541.11 / $3,632.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.50 / $1,698.73 / $1,930.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.13 / $1,046.93 / $1,046.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.40 / $1,570.40 / $1,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.13 / $1,046.93 / $1,046.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.20 / $1,185.20 / $1,570.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.00 / $3,464.58
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.13 / $1,046.93 / $1,046.93
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.40 / $1,570.40 / $1,570.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.91 / $1,849.91 / $1,849.91
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,234.64 / $5,234.64 / $5,234.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.93 / $1,046.93 / $1,046.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.66 / $1,469.89 / $1,655.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.20 / $1,185.20 / $1,622.78