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HYALOMATRIX

Washington rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $219 · 10th–90th $17$4070%10%10th90th$219Professionalmedian $25 · 10th–90th $23$1910%50%10th90th$25$20.0$50.0$100.0$200.0$500.0$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
$24.55
Median
$24.55
Typical High
$24.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$24.55
Typical High
$75.86
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$169.82
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$288.40
Typical High
$467.74
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$275.42
Typical High
$363.08
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$16.98
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$23.99
Median
$23.99
Typical High
$24.55
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$24.55
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
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
$154.88
Typical High
$295.12