APC 00877
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Orthovisc inj per dose
Low
$111
Average
$158
Median
$155
High
$229
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
16 payers; the 90th percentile is 1.9× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Humana fee schedule · outpatient · +1 other terms | 86 | $108 | $120 | $38 | 32% | — | $83 – $231 |
| 2 | Caresource fee schedule · outpatient · +1 other terms | 20 | $111 | $141 | $51 | 36% | — | $111 – $229 |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +1 other terms | 11 | $111 | $171 | $55 | 32% | — | $111 – $223 |
| 4 | Aetna fee schedule · outpatient · +1 other terms | 5 | $227 | $226 | $1 | 0% | — | $225 – $227 |
| 5 | Clover fee schedule · outpatient | 5 | $223 | $223 | — | — | — | $223 – $223 |
| 6 | Kaiser fee schedule · outpatient · +1 other terms | 5 | $229 | $229 | — | — | — | $229 – $229 |
| 7 | Medicare fee schedule · outpatient · +1 other terms | 5 | $223 | $223 | — | — | — | $223 – $223 |
| 8 | UnitedHealthcare fee schedule · outpatient · +1 other terms | 5 | $223 | $223 | — | — | — | $223 – $223 |
| 9 | WellCare fee schedule · outpatient | 5 | $229 | $229 | — | — | — | $229 – $229 |
| 10 | Carefirst facility · fee schedule · outpatient | 3 | $111 | $111 | — | — | — | $111 – $111 |
| 11 | Tricare facility · fee schedule · outpatient | 3 | $111 | $111 | — | — | — | $111 – $111 |
| 12 | Aetna Better Health facility · other · outpatient · +1 other terms | 2 | $111 | $111 | — | — | — | $111 – $111 |
| 13 | Anthem facility · fee schedule · outpatient | 2 | $111 | $111 | — | — | — | $111 – $111 |
| 14 | Medical Mutual facility · other · outpatient | 2 | $196 | $196 | $7 | 3% | — | $189 – $203 |
| 15 | Bcbs Mi facility · fee schedule · outpatient | 1 | $111 | $111 | — | — | — | $111 – $111 |
| 16 | Medica facility · fee schedule · outpatient | 1 | $116 | $116 | — | — | — | $116 – $116 |
← Hospitals reporting APC 00877 · Snapshot 20261111T120946Z-9134e7f7