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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 October 2026.

How much does HYALOMATRIX cost?

$28.84

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $28.84 for this service. The price depends on where it is billed: about $28.84 from a physician practice, and about $28.84 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$28.84$24.55 to $38.90
FacilityA hospital or hospital-owned outpatient department$28.84$28.84 to $33.11

How much rates vary

Facilitymedian $29 · 10th to 90th $29 to $44Professionalmedian $29 · 10th to 90th $17 to $126
$20$50$100$200facility $29professional $29

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
$22.91
Median
$22.91
Typical High
$22.91
Aetna
Setting
Professional
Modifier
None
Typical Low
$24.55
Median
$24.55
Typical High
$28.84
Cigna
Setting
Facility
Modifier
None
Typical Low
$22.91
Median
$28.84
Typical High
$169.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$17.38
Median
$21.38
Typical High
$28.84
Medica
Setting
Facility
Modifier
None
Typical Low
$28.84
Median
$43.65
Typical High
$43.65
Medica
Setting
Professional
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$109.65
Midlands
Setting
Professional
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Midlands
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$141.25
Wellmark
Setting
Facility
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Wellmark
Setting
Professional
Modifier
None
Typical Low
$28.84
Median
$28.84
Typical High
$28.84

Where South Dakota 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.

South Dakota· 29th of 51

$28.84

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.