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Dextranomer/Hyaluronic Acid Bulking Agent, Urinary Tract

Tennessee 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 rates vary

Facilitymedian $2,399 · 10th to 90th $100 to $4,169Professionalmedian $2,399 · 10th to 90th $95 to $2,399
$100$200$500$1K$2Kfacility $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
$4,168.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$2,398.83
Typical High
$2,398.83
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00