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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

Facilitymedian $2,239 · 10th–90th $95–$3,0200%20%10th90th$2,239Professionalmedian $2,399 · 10th–90th $1,549–$3,3880%50%10th90th$2,399$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $2,398.83 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $2,187.76 / $6,456.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,388.44 / $3,388.44
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $2,398.83 / $3,019.95
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $2,398.83 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,548.13