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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
$95.50 / $95.50 / $95.50
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
$812.83 / $2,187.76 / $6,456.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,388.44 / $3,388.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $2,398.83 / $3,019.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,090.30 / $3,548.13