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HYALOMATRIX

Indiana rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $257 · 10th–90th $23$5130%10%10th90th$257Professionalmedian $23 · 10th–90th $17$1260%50%10th90th$23$20.0$50.0$100.0$200.0$500.0

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
$22.91
Typical High
$24.55
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$275.42
Typical High
$512.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$20.42
Typical High
$37.15
CareSource
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$346.74
Typical High
$524.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89