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Michigan 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 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $162.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $162.18 / $173.78
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,981.07 / $12,302.69
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,168.69 / $5,623.41