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Wisconsin 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
$100.63 / $195.40 / $1,868.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $245.82 / $479.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.18 / $211.90 / $255.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $114.54 / $145.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.81 / $156.81 / $183.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.54 / $298.43 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.69 / $203.74 / $231.53
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.70 / $97.70 / $230.00
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.25 / $229.08 / $229.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.70 / $97.70 / $230.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.70 / $97.70 / $229.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $97.70 / $125.30
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.70 / $97.70 / $230.00
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.25 / $229.08 / $229.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.53 / $145.66 / $307.97
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.04 / $642.04 / $642.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $114.54 / $114.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.09 / $160.81 / $232.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $114.54 / $183.26