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HYALOMATRIX

Missouri rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $30 · 10th–90th $23$2090%20%10th90th$30Professionalmedian $58 · 10th–90th $23$1320%20%10th90th$58$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
$30.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.44
Typical High
$38.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$109.65
Typical High
$134.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$28.84
Typical High
$64.57
Medica
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$28.84
Typical High
$109.65
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$102.33
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$125.89
Typical High
$125.89