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Idaho 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
$95.00 / $95.00 / $95.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $2,374.87 / $2,374.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,080.00 / $2,374.87 / $2,497.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00