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Pennsylvania 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 / $2,754.23 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,398.83 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $4,365.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,511.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60