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Payers and negotiated rates for APC 0877 | medprice.ai

APC 0877

Orthovisc inj per dose

Payers reporting APC 0877

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Payer pricing summary

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Low

$8

Average

$153

Median

$115

High

$456

Payer rate distribution

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#
1	Excellus case rate · outpatient	2	$115	$115	—	—	2–20	$115 – $115
2	Aetna facility · fee schedule · outpatient · +4 other terms	5	$118	$117	$1	1%	—	$115 – $118
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +5 other terms	5	$289	$300	$100	33%	—	$120 – $434
4	Humana facility · fee schedule · outpatient · +2 other terms	5	$119	$118	$0	0%	—	$118 – $119
5	Tricare facility · fee schedule · outpatient	5	$115	$115	—	—	—	$115 – $115
6	UnitedHealthcare facility · fee schedule · outpatient · +2 other terms	5	$115	$115	—	—	—	$115 – $115
7	WellCare facility · fee schedule · outpatient	5	$8	$8	$0	2%	—	$8 – $8
8	Cigna case rate · outpatient · +2 other terms	2	$115	$115	—	—	—	$115 – $115
9	Highmark case rate · outpatient	2	$115	$115	—	—	—	$115 – $115
10	Sanford Health Plan case rate · outpatient	2	$140	$140	$15	11%	—	$118 – $163
11	Aetna Better Health facility · case rate · outpatient	1	$88	$88	$28	32%	—	$60 – $117
12	Ambetter facility · case rate · outpatient	1	$60	$60	—	—	—	$60 – $60
13	Medicaid facility · case rate · outpatient	1	$60	$60	—	—	—	$60 – $60
14	Molina facility · case rate · outpatient	1	$88	$88	$28	32%	—	$60 – $117

← Hospitals reporting APC 0877 · Snapshot 20261111T120946Z-9134e7f7