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HYALOMATRIX

North Dakota rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $23 · 10th–90th $23$320%50%90th$23Professionalmedian $26 · 10th–90th $23$340%20%10th90th$26$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
Facility
Modifier
Global
Typical Low
$22.91
Median
$22.91
Typical High
$28.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.99
Typical High
$38.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$26.30
Typical High
$33.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$26.92
Typical High
$30.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$21.38
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$25.70
Typical High
$43.65
Medica
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$32.36
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$125.89
Typical High
$239.88