Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HB-Hyalomatrix 2.5 X 2.5 Mss4011
Low
$19
Average
$162
Median
$113
High
$972
Filter by billing methodology
Prices here combine facility and professional fees. See them separately →Experimental
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 32 hospitals; the 90th percentile is 7.1× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | SwedishAmerican Hospital Rockford, IL | $135 | $135 | $5 | 4% | — | $130 – $140 |
| 2 | Columbia St. Mary's Hospital Ozaukee, Inc. Mequon, WI | $69 | $69 | — | — | — | $69 – $69 |
| 3 | Mercy Hospital Springfield Ozark, MO | $129 | $150 | $46 | 31% | — | $125 – $242 |
| 4 | Fairfield Medical Center Lancaster, OH | $159 | $159 | $39 | 25% | — | $120 – $198 |
| 5 | Bay Park Community Hospital Oregon, OH | $74 | $201 | $188 | 93% | — | $63 – $466 |
| 6 | Ukiah Adventist Hospital Ukiah, CA | $139 | $162 | $45 | 28% | — | $139 – $251 |
| 7 | Mercy Hospital Jefferson Festus, MO | $125 | $135 | $32 | 23% | — | $125 – $286 |
| 8 | Inova Alexandria Hospital Alexandria, VA | $42 | $42 | — | — | — | $42 – $42 |
| 9 | Emma L Bixby Medical Center Adrian, MI | $74 | $97 | $38 | 39% | — | $56 – $143 |
| 10 | Glendale Adventist Medical Center Glendale, CA | $151 | $169 | $66 | 39% | — | $51 – $339 |
Ask Claude or any MCP client for HCPCS Q4117 pricing at a specific hospital — see how to connect.