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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
$5,905.03 / $5,905.03 / $5,905.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $2,080.00 / $2,497.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.38 / $741.95 / $1,343.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.04 / $205.38 / $279.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.00 / $2,374.87 / $2,374.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87