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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

South Carolina 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 South Carolina, 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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,399 · 10th to 90th $1,820 to $2,884Professionalmedian $2,399 · 10th to 90th $2,089 to $2,399
$50$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
$1,819.70
Median
$1,819.70
Typical High
$2,398.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$2,398.83
Typical High
$2,398.83
Medcost
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$4,073.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20

Where South Carolina 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.

South Carolina· 31st 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.