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New York 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
$2,754.23 / $9,549.93 / $22,387.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,511.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $66.07 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $53,703.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,018.94 / $38,018.94 / $38,018.94
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,467.37 / $3,467.37
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,467.37
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,467.37 / $3,801.89
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,467.37