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North Carolina 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
$2,374.87 / $4,638.41 / $25,965.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $49.76 / $60.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,849.84
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00