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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Pennsylvania 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 facility fee. In Pennsylvania, July 2026.

Insurers have agreed to pay about $2,399 for this service. Most negotiated rates run $2,399 to $2,399.

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.

How much rates vary

Facilitymedian $2,399 · 10th to 90th $2,399 to $4,266Professionalmedian $2,399 · 10th to 90th $2,399 to $2,399
$100$200$500$1K$2K$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
$3,981.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$3,801.89
Typical High
$3,801.89
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$3,467.37
Typical High
$4,365.16
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$3,162.28
Typical High
$4,677.35

Where Pennsylvania 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.

Pennsylvania· 20th 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.