go back

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
$2,374.87 / $2,374.87 / $2,374.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $2,374.87 / $2,374.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.84 / $80.06 / $114.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.77 / $138.27 / $188.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.70 / $1,107.70 / $1,107.70
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.87 / $3,569.40 / $3,966.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.12 / $2,374.87 / $3,635.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00