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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Georgia rates for HCPCS L8604

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

Rates data updated July 2026.

How much rates vary

Facilitymedian $5,623 · 10th to 90th $2,399 to $14,454Professionalmedian $2,399 · 10th to 90th $112 to $2,399
$100$200$500$1K$2K$5K$10Kfacility $5,623professional $2,399

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$5,623.41
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$112.20
Typical High
$117.49