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Nebraska 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 / $9,120.11 / $25,703.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $2,398.83 / $2,398.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,162.28 / $6,165.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,398.83 / $4,365.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83