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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
$2,398.83 / $2,398.83 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,398.83 / $2,398.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $123.03 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $123.03 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18