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HYALOMATRIX

California rates for HCPCS Q4117

HYALOMATRIX, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

Facilitymedian $31 · 10th–90th $25$1410%50%10th90th$31Professionalmedian $25 · 10th–90th $20$1510%50%10th90th$25$0.1$2.0$50.0$1.0K$20.0K$500.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.99
Typical High
$75.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$30.90
Typical High
$77.62
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$28.84
Typical High
$54.95
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$20.42
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$10.47
Typical High
$239.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$269.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$16.98
Providence
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$51.29
Typical High
$229.09
Providence
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$125.89
Typical High
$125.89
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$13.18
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$151.36