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HYALOMATRIX

New Hampshire 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 $25$2950%20%10th90th$30Professionalmedian $25 · 10th–90th $17$540%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
$24.55
Median
$24.55
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$24.55
Typical High
$34.67
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$28.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$31.62
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$37.15
Typical High
$125.89
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$38.90