go back

Indiana 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
$2,374.87 / $2,374.87 / $2,374.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $2,374.87 / $2,374.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.22 / $124.22 / $239.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.48 / $124.22 / $167.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.97 / $163.97 / $163.97