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Minnesota 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 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $691.83 / $1,659.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $169.82 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,398.83 / $3,981.07