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South 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
$1,799.45 / $1,799.45 / $2,374.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $3,206.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00