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Arizona rates for HCPCS L8604

Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $2,398.83 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $489.78 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $234.42 / $446.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $134.90 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83