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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 October 2026.

How much does HYALOMATRIX cost?

$24.55

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $24.55 for this service. The price depends on where it is billed: about $24.55 from a physician practice, and about $170 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$24.55$23.99 to $126
FacilityA hospital or hospital-owned outpatient department$170$30.20 to $214

How much rates vary

Facilitymedian $170 · 10th to 90th $23 to $479Professionalmedian $25 · 10th to 90th $22 to $126
$10$100$1K$10Kfacility $170professional $25

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
Aetna
Setting
Professional
Modifier
None
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$21.38
Median
$23.99
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$21.88
Median
$23.99
Typical High
$23.99
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$20.89
Median
$24.55
Typical High
$218.78
Geisinger
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$144.54
Typical High
$208.93
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$17.78
Median
$20.89
Typical High
$26.30
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$8.71
Median
$10.00
Typical High
$10.00
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$8.71
Median
$10.00
Typical High
$10.00
United
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$125.89
Typical High
$134.90

Where Pennsylvania sits

The same service costs 8.3 times more in North Dakota than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 48th of 51

$24.55

ND $141KY $16.98

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.