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Montana 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
Professional
Modifier
Low / Median / High Price
$95.50 / $2,398.83 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $114.82 / $2,511.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $85.11