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HYALOMATRIX

New York 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$1740%20%40%10th90th$30Professionalmedian $25 · 10th–90th $19$1260%20%40%10th90th$25$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$19.95
Median
$22.91
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.99
Typical High
$27.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$28.84
Typical High
$28.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$138.04
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$24.55
Typical High
$239.88
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$30.20
Typical High
$30.20
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$30.20
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$24.55
Typical High
$24.55
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$24.55
Typical High
$134.90
Univera
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$30.20
Typical High
$30.20
Univera
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$30.20