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
HC (SUP SHELL Q4117) HYALOMATRIX
Low
$5
Average
$522
Median
$24
High
$2.6k
Each hospital's average Aetna Better Health rate, under the methodology and billing class chosen below.
37 hospitals; the 90th percentile is 498.5× 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.
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53 hospital rates
iThe hospitals that file a Aetna Better Health rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 2 | $93 | $93 | $30 | 33% | — | $63 – $124 |
| 2 | Bay Park Community Hospital Oregon, OH facility · other · outpatient | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 3 | Bay Park Community Hospital Oregon, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $553 | $553 | — | — | — | $553 – $553 |
| 4 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 2 | $18 | $18 | $0 | 2% | — | $18 – $18 |
| 5 | Carle BroMenn Medical Center Normal, IL fee schedule · inpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 6 | Carle BroMenn Medical Center Normal, IL fee schedule · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 7 | Carle Eureka Hospital Eureka, IL fee schedule · inpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 8 | Carle Eureka Hospital Eureka, IL fee schedule · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 9 | Emma L Bixby Medical Center Adrian, MI facility · other · outpatient | 1 | $74 | $74 | — | — | — | $74 – $74 |
| 10 | Emma L Bixby Medical Center Adrian, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 11 | Emma L Bixby Medical Center Adrian, MI professional · fee schedule · outpatient | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 12 | FAIRVIEW PARK HOSPITAL DUBLIN, GA fee schedule · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 13 | Fostoria Hospital Association Fostoria, OH facility · fee schedule · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 14 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 15 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 16 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 17 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 1 | $68 | $68 | — | — | — | $68 – $68 |
| 18 | Hoopeston Community Memorial Hospital Hoopeston, IL fee schedule · inpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 19 | Hoopeston Community Memorial Hospital Hoopeston, IL fee schedule · outpatient | 1 | $24 | $24 | — | — | — | $24 – $24 |
| 20 | Inspira Health Center Bridgeton Bridgeton, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 21 | Inspira Health Center Woodbury Woodbury, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 22 | Inspira Medical Center Elmer Elmer, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 23 | Inspira Medical Center Mannington Salem, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 24 | Inspira Medical Center Mullica Hill Hill, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 25 | Inspira Medical Center Vineland Vineland, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $5 | $5 | — | — | — | $5 – $5 |
← Payers reporting HCPCS Q4117 · Snapshot 20261112T124536Z-e251e855