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HYALOMATRIX

Texas rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $34 · 10th–90th $17$2140%10%20%10th90th$34Professionalmedian $24 · 10th–90th $23$1260%50%10th90th$24$2.0$10.0$50.0$200.0$1.0K

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
$22.91
Median
$23.44
Typical High
$23.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$23.44
Typical High
$24.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$30.90
Typical High
$75.86
BCBS
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$23.99
Christus
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$120.23
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$302.00
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$24.55
Typical High
$141.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$234.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$30.20
Typical High
$33.11
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$302.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$33.88
Typical High
$208.93
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$120.23
Typical High
$169.82