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HYALOMATRIX

South Dakota rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $29 · 10th–90th $23$490%50%10th90th$29Professionalmedian $25 · 10th–90th $17$1100%20%40%10th90th$25$20.0$50.0$100.0$200.0

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
$22.91
Median
$22.91
Typical High
$22.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$24.55
Typical High
$28.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$28.84
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$21.38
Typical High
$21.38
Medica
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$38.90
Typical High
$51.29
Medica
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$109.65
Midlands
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84