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HYALOMATRIX

Michigan 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$1260%20%40%10th90th$29Professionalmedian $24 · 10th–90th $23$1260%50%10th90th$24$20.0$50.0$100.0$200.0

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
$24.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$125.89
Typical High
$125.89
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$30.20
Typical High
$81.28
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$21.88
Median
$30.20
Typical High
$138.04
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$18.20
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$125.89