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Massachusetts rates for HCPCS L8604

Injectable Bulking Agent Dextranomer/Hyaluronic Acid Copolymer Implant

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
$2,374.87 / $2,374.87 / $2,497.23
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $818.35
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00