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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

Facilitymedian $933 · 10th–90th $170$13,8040%10%20%10th90th$933Professionalmedian $170 · 10th–90th $135$2,3990%50%10th90th$170$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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 / $13,803.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,398.83 / $2,398.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $691.83 / $1,659.59
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $169.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $2,398.83 / $3,981.07