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Ohio 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
$95.00 / $95.00 / $14,905.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.00 / $95.00 / $2,374.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.48 / $118.66 / $181.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.70 / $1,107.70 / $1,107.70
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,402.28 / $7,402.28 / $7,402.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00