go back

HYALOMATRIX

Montana 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 $9$630%20%40%10th90th$30Professionalmedian $24 · 10th–90th $23$1260%50%10th90th$24$10.0$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
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.99
Typical High
$24.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$144.54
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$18.20
Median
$125.89
Typical High
$181.97
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$29.51
Typical High
$33.11
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$29.51
Typical High
$33.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$27.54
Typical High
$204.17
Providence
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$79.43
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89