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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

South Dakota 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 South Dakota, July 2026.

Insurers have agreed to pay about $2,399 for this service. Most negotiated rates run $2,399 to $3,388.

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 $8,511 · 10th to 90th $3,388 to $8,511Professionalmedian $2,399 · 10th to 90th $95 to $3,388
$100$200$500$1K$2K$5Kfacility $8,511professional $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
$8,511.38
Median
$8,511.38
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$2,398.83
Typical High
$2,398.83
Medica
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$3,981.07
Typical High
$4,265.80
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,388.44

Where South Dakota 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 Dakota· 40th 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.