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HYALOMATRIX

North Carolina rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $25 · 10th–90th $19$2000%10%20%10th90th$25Professionalmedian $25 · 10th–90th $15$1200%20%10th90th$25$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
$19.50
Median
$19.50
Typical High
$19.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$23.44
Typical High
$24.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$144.54
Typical High
$151.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$30.20
Typical High
$30.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$24.55
Typical High
$44.67
Medcost
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$208.93
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$125.89
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69