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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Idaho 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 does Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract cost?

$2,399

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $2,399 for this service. The price depends on where it is billed: about $2,399 from a physician practice, and about $2,344 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2,399$2,399 to $2,570
FacilityA hospital or hospital-owned outpatient department$2,344$95.50 to $2,399

How much rates vary

Facilitymedian $2,344 · 10th to 90th $95 to $2,818Professionalmedian $2,399 · 10th to 90th $2,399 to $3,388
$100$200$500$1K$2K$5Kfacility $2,344professional $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
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$2,398.83
Typical High
$2,511.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$2,187.76
Typical High
$6,456.54
BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,235.94
Median
$3,388.44
Typical High
$3,388.44
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$2,398.83
Typical High
$3,019.95
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$77.62
Select Health
Setting
Professional
Modifier
Global
Typical Low
$2,570.40
Median
$3,311.31
Typical High
$3,548.13

Where Idaho sits

The same service costs 26.3 times more in Vermont than in Mississippi. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Idaho· 15th of 51

$2,399

VT $2,512MS $95.50

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.