APC 877

Orthovisc injection, per dose

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Orthovisc inj per dose

Payers reporting APC 877

Payer pricing summary

Low

$109

Average

$132

Median

$116

High

$228

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +2 other terms	174	$112	$110	$6	5%	—	$92 – $117
2	Humana fee schedule · outpatient · +4 other terms	161	$111	$113	$33	29%	—	$92 – $445
3	Aetna fee schedule · outpatient · +3 other terms	155	$112	$111	$11	10%	—	$92 – $161
4	WellCare fee schedule · outpatient · +2 other terms	131	$115	$113	$6	5%	—	$92 – $147
5	Blue Cross Blue Shield fee schedule · outpatient · +3 other terms	125	$113	$111	$5	4%	—	$94 – $116
6	Devoted fee schedule · outpatient · +2 other terms	122	$111	$110	$3	3%	—	$100 – $117
7	Cigna Healthspring fee schedule · outpatient · +1 other terms	110	$113	$110	$7	6%	—	$100 – $119
8	Molina fee schedule · outpatient · +1 other terms	69	$164	$155	$64	41%	—	$92 – $292
9	Superior Healthplan fee schedule · outpatient	40	$117	$116	$2	2%	—	$105 – $117
10	Anthem fee schedule · outpatient · +2 other terms	31	$111	$108	$8	8%	—	$92 – $115
11	Oscar fee schedule · outpatient · +1 other terms	27	$109	$117	$16	14%	—	$107 – $161
12	Amerihealth Caritas fee schedule · outpatient · +1 other terms	17	$134	$130	$7	6%	—	$114 – $134
13	Cigna fee schedule · outpatient · +1 other terms	16	$113	$113	$25	22%	—	$92 – $201
14	Clover fee schedule · outpatient · +2 other terms	15	$115	$115	$3	2%	—	$105 – $117
15	Kaiser fee schedule · outpatient · +2 other terms	15	$113	$111	$6	6%	—	$94 – $113
16	Ambetter case rate · outpatient · +1 other terms	12	$206	$238	$37	16%	—	$206 – $282
17	Medicare case rate · outpatient · +2 other terms	8	$115	$115	—	—	—	$115 – $115
18	Optum fee schedule · outpatient · +2 other terms	8	$112	$162	$74	45%	—	$100 – $273
19	Bcbs Nj facility · other · outpatient	3	$111	$111	—	—	—	$111 – $111
20	Highmark case rate · outpatient · +2 other terms	3	$177	$168	$57	34%	—	$115 – $251
21	Excellus case rate · outpatient	2	$228	$228	$29	13%	—	$198 – $257
22	Medica facility · fee schedule · outpatient	2	$117	$117	—	—	—	$117 – $117
23	Magellan fee schedule · outpatient	1	$111	$111	—	—	—	$111 – $111
24	Sanford Health Plan case rate · outpatient	1	$148	$148	$12	8%	—	$136 – $160