| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,497.23 | $2,497.23 | $2,497.23 | |
Aetna
| Professional | $2,374.87 | $2,497.23 | $2,497.23 | |
Molina
| Professional | $35.00 | $45.00 | $60.00 |
Injectable Bulking Agent Dextranomer/Hyaluronic Acid Copolymer Implant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,497.23 | $2,497.23 | $2,497.23 | |
Aetna
| Professional | $2,374.87 | $2,497.23 | $2,497.23 | |
Molina
| Professional | $35.00 | $45.00 | $60.00 |