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HYALOMATRIX

Wisconsin rates for HCPCS Q4117

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

Rates data updated July 2026.

Facilitymedian $37 · 10th–90th $17$4900%10%20%10th90th$37Professionalmedian $29 · 10th–90th $23$3020%20%10th90th$29$5.0$20.0$100.0$500.0$2.0K

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
$22.91
Typical High
$22.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$22.91
Typical High
$28.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$28.84
Typical High
$407.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$54.95
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$125.89
Typical High
$223.87
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$22.91
Typical High
$35.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$22.91
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$109.65
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$17.78
Median
$17.78
Typical High
$17.78
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$22.91
Typical High
$35.48
Quartz
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$229.09
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$131.83
Typical High
$660.69
Security Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Security Health
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$28.18
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54