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Utah rates for HCPCS L8604

Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies

Facilitymedian $2,512 · 10th–90th $2,512–$2,5120%50%100%$2,512Professionalmedian $2,399 · 10th–90th $95–$2,5120%50%10th90th$2,399$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $2,398.83 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,548.13