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South Dakota rates for HCPCS J7321

Hyaluronan or derivative, Hyalgan, Supartz or Visco-3, for intra-articular injection, per dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $74.13 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $93.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $123.03 / $199.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $74.13 / $74.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $79.43 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $95.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79