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South Dakota rates for HCPCS J7324

Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.54 / $114.54 / $114.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $118.22 / $491.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.69 / $127.69 / $159.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.56 / $165.11 / $495.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.70 / $97.70 / $125.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.56 / $150.36 / $187.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.07 / $150.36 / $214.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.34 / $125.34 / $487.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $114.54 / $125.99
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.70 / $97.70 / $97.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.70 / $97.70 / $97.70