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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Mississippi 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 $95 · 10th to 90th $95 to $95Professionalmedian $95 · 10th to 90th $95 to $2,399
$100$200$500$1K$2Kfacility $95professional $95

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
$95.50
Median
$95.50
Typical High
$2,398.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83