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Wisconsin rates for HCPCS L8604

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

Facilitymedian $2,399 · 10th–90th $2,399–$3,6310%50%90th$2,399Professionalmedian $2,399 · 10th–90th $95–$2,3990%50%10th$2,399$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$2,398.83 / $2,398.83 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $2,398.83 / $2,398.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $154.88 / $154.88
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,398.83 / $4,265.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $2,398.83 / $3,630.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $549.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $3,981.07 / $3,981.07
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $100.00