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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,497.23 / $2,497.23 / $2,497.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,497.23 / $2,497.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $45.00 / $60.00