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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Minnesota 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?

$170

Typical facility fee. In Minnesota, July 2026.

Insurers have agreed to pay about $170 for this service. Most negotiated rates run $162 to $170.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $1,660 · 10th to 90th $170 to $8,511Professionalmedian $170 · 10th to 90th $135 to $2,399
$1$10$100$1K$10Kfacility $1,660professional $170

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
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$2,398.83
Typical High
$2,398.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$691.83
Typical High
$1,659.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Medica
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$2,398.83
Typical High
$3,981.07

Where Minnesota 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.

Minnesota· 47th of 51

$170

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.