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Montana rates for HCPCS L8604

Injectable Bulking Agent Dextranomer/Hyaluronic Acid Copolymer Implant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $1,800,000.00 / $2,250,000.00