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HYALOMATRIX

Minnesota rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $43 · 10th–90th $25$2570%10%20%10th90th$43Professionalmedian $102 · 10th–90th $17$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$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
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.44
Typical High
$28.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$37.15
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$45.71
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$20.42
Typical High
$21.88
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$30.90
Median
$44.67
Typical High
$64.57
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$23.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$38.90
Medica
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$125.89
Typical High
$239.88