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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

Facilitymedian $2,399 · 10th–90th $2,399–$10,4710%50%90th$2,399Professionalmedian $2,399 · 10th–90th $162–$2,5120%50%10th90th$2,399$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,398.83 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,398.83 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $33.11 / $33.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $162.18 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,981.07 / $12,302.69
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $4,168.69 / $5,623.41
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48