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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

New York 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 New York, July 2026.

Insurers have agreed to pay about $2,399 for this service. The price depends on where it is billed: about $209 from a physician practice, and about $3,388 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 7 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$209$66.07 to $2,399
FacilityA hospital or hospital-owned outpatient department$3,388$2,512 to $6,166

How much rates vary

Facilitymedian $3,388 · 10th to 90th $2,399 to $7,413Professionalmedian $209 · 10th to 90th $56 to $2,399
$100$200$500$1K$2K$5K$10Kfacility $3,388professional $209

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
$2,884.03
Typical High
$7,413.10
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
$53.70
Median
$66.07
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,388.44
Median
$3,467.37
Typical High
$3,467.37
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,467.37
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$64.57
Univera
Setting
Facility
Modifier
Global
Typical Low
$3,388.44
Median
$3,467.37
Typical High
$3,801.89
Univera
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,467.37

Where New York 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.

New York· 9th 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.