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Virginia rates for HCPCS L8604

Injectable Bulking Agent Dextranomer/Hyaluronic Acid Copolymer Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $2,374.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.48 / $112.57 / $114.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.87 / $2,374.87 / $3,616.93
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00