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HYALOMATRIX

Iowa rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $29 · 10th–90th $23$1070%50%10th90th$29Professionalmedian $25 · 10th–90th $23$1260%20%40%10th90th$25$0.1$0.2$1.0$5.0$20.0$100.0

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
$22.91
Median
$22.91
Typical High
$22.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.99
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$245.47
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$21.38
Typical High
$50.12
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$33.11
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$18.62
Median
$27.54
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$28.84
Typical High
$50.12
Midlands
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$23.99
Typical High
$28.84
Midlands
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$239.88
Typical High
$302.00
Midlands
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$26.30
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$114.82
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$134.90
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$28.84
Typical High
$28.84