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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 October 2026.

How much does HYALOMATRIX cost?

$28.84

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $28.84 for this service. The price depends on where it is billed: about $28.84 from a physician practice, and about $35.48 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$28.84$21.88 to $186
FacilityA hospital or hospital-owned outpatient department$35.48$28.84 to $51.29

How much rates vary

Facilitymedian $35 · 10th to 90th $25 to $251Professionalmedian $29 · 10th to 90th $17 to $234
$20$50$100$200facility $35professional $29

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
None
Typical Low
$23.44
Median
$28.84
Typical High
$28.84
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$24.55
Median
$38.90
Typical High
$257.04
BCBS Minnesota
Setting
Professional
Modifier
None
Typical Low
$23.44
Median
$194.98
Typical High
$239.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$25.70
Median
$41.69
Typical High
$64.57
Cigna
Setting
Professional
Modifier
None
Typical Low
$17.38
Median
$19.05
Typical High
$21.88
Health Partners
Setting
Facility
Modifier
None
Typical Low
$22.91
Median
$37.15
Typical High
$63.10
Health Partners
Setting
Professional
Modifier
None
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
Medica
Setting
Facility
Modifier
None
Typical Low
$16.98
Median
$16.98
Typical High
$48.98
Medica
Setting
Professional
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$109.65
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$186.21
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
BCBS Minnesota
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$6.46
Median
$12.59
Typical High
$125.89

Where Minnesota sits

The same service costs 8.3 times more in North Dakota than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Minnesota· 36th of 51

$28.84

ND $141KY $16.98

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.