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HYALOMATRIX

South Carolina rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $28 · 10th–90th $23$1820%20%10th90th$28Professionalmedian $24 · 10th–90th $19$1260%50%10th90th$24$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
$23.44
Median
$23.44
Typical High
$23.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$23.44
Typical High
$24.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$18.62
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$28.84
Typical High
$66.07
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$125.89
Typical High
$125.89