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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Michigan 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 Michigan, 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 $2,399 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$162 to $2,399
FacilityA hospital or hospital-owned outpatient department$2,399$2,399 to $3,548

How much rates vary

Facilitymedian $2,399 · 10th to 90th $2,399 to $10,471Professionalmedian $2,399 · 10th to 90th $102 to $3,548
$50$200$1K$5Kfacility $2,399professional $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
$2,398.83
Typical High
$2,398.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$2,398.83
Typical High
$2,511.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$162.18
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$3,981.07
Typical High
$12,302.69
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$4,168.69
Typical High
$5,623.41
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48

Where Michigan 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.

Michigan· 28th 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.