| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.83 | $15,488.17 | $15,488.17 | |
Aetna
| Professional | $2,398.83 | $2,398.83 | $2,398.83 | |
Lucent Health
| Facility | $64.57 | $100.00 | $100.00 |
Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.83 | $15,488.17 | $15,488.17 | |
Aetna
| Professional | $2,398.83 | $2,398.83 | $2,398.83 | |
Lucent Health
| Facility | $64.57 | $100.00 | $100.00 |