go back

Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Ohio 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?

$135

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $135 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $158 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$132$107 to $229
FacilityA hospital or hospital-owned outpatient department$158$95.50 to $2,399

How much rates vary

Facilitymedian $158 · 10th to 90th $95 to $7,413Professionalmedian $132 · 10th to 90th $95 to $2,399
$100$200$500$1K$2K$5Kfacility $158professional $132

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
$158.49
Typical High
$7,413.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$2,398.83
Typical High
$2,398.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$128.82
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$7,943.28
Typical High
$7,943.28
Molina
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$50.12
Typical High
$60.26

Where Ohio 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.

Ohio· 48th of 51

$135

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.