Hyalomatrix wound matrix dressing

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC (SUP SHELL Q4117) HYALOMATRIX

Payers reporting HCPCS Q4117

Payer pricing summary

Low

$19

Average

$676

Median

$177

High

$12.0k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +18 other terms	462	$143	$183	$334	182%	—	$1 – $6.2k
2	Cigna fee schedule · outpatient · +18 other terms	262	$67	$394	$1.5k	370%	—	$6 – $13.5k
3	Aetna fee schedule · outpatient · +18 other terms	253	$125	$222	$437	197%	—	$6 – $3.5k
4	Blue Cross Blue Shield fee schedule · outpatient · +21 other terms	212	$92	$212	$949	449%	—	$0 – $11.5k
5	Humana fee schedule · outpatient · +17 other terms	113	$125	$165	$192	117%	—	$1 – $977
6	Molina fee schedule · outpatient · +15 other terms	69	$191	$153	$310	202%	—	$1 – $3.4k
7	Anthem facility · fee schedule · outpatient · +15 other terms	60	$118	$162	$155	95%	—	$17 – $1.2k
8	WellCare fee schedule · outpatient · +9 other terms	54	$135	$128	$41	32%	—	$6 – $171
9	Kaiser fee schedule · outpatient · +12 other terms	51	$207	$840	$1.9k	223%	—	$9 – $11.3k
10	Optum fee schedule · outpatient · +4 other terms	38	$125	$275	$211	77%	—	$113 – $830
11	Ambetter fee schedule · outpatient · +5 other terms	37	$234	$272	$97	36%	—	$162 – $859
12	Devoted fee schedule · outpatient · +8 other terms	34	$125	$125	$8	6%	—	$116 – $139
13	MultiPlan fee schedule · inpatient · +11 other terms	34	$1.4k	$3.4k	$3.8k	109%	—	$7 – $14.6k
14	Bcbs Tx fee schedule · outpatient · +3 other terms	30	$83	$75	$25	33%	—	$31 – $130
15	Caresource facility · fee schedule · outpatient · +8 other terms	29	$192	$154	$76	49%	—	$17 – $248
16	First Health fee schedule · outpatient · +10 other terms	22	$1.8k	$3.3k	$3.2k	97%	—	$65 – $12.2k
17	Regence professional · fee schedule · outpatient · +8 other terms	20	$9	$16	$31	197%	—	$9 – $153
18	Healthpartners fee schedule · outpatient · +1 other terms	19	$20	$23	$18	78%	—	$20 – $131
19	Medical Mutual facility · fee schedule · outpatient · +7 other terms	19	$93	$89	$77	87%	—	$28 – $468
20	Medicare fee schedule · outpatient · +5 other terms	19	$125	$122	$13	11%	—	$60 – $125
21	Oscar facility · fee schedule · outpatient · +7 other terms	19	$182	$196	$25	13%	—	$175 – $234
22	Highmark fee schedule · outpatient · +7 other terms	16	$27	$86	$347	403%	—	$24 – $3.4k
23	Medica fee schedule · both · +11 other terms	15	$34	$67	$48	72%	—	$31 – $139
24	Medcost facility · percent of total billed charges · bothfrom % of charges · +4 other terms	14	$29	$31	$13	42%	—	$17 – $65
25	Wellmark fee schedule · both · +4 other terms	13	$29	$28	$2	9%	—	$14 – $29

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