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HYALOMATRIX

Pennsylvania 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 $24$4470%50%10th90th$25Professionalmedian $25 · 10th–90th $23$1260%50%10th90th$25$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$24.55
Median
$24.55
Typical High
$41.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$24.55
Typical High
$24.55
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$20.42
Median
$23.99
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$23.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$223.87
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$218.78
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$41.69
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$24.55
Typical High
$28.84
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$10.00
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$10.00
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$125.89
Typical High
$138.04