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
$1
Average
$170
Median
$190
High
$676
Each hospital's average Caresource rate, under the methodology and billing class chosen below.
79 hospitals; the 90th percentile is 10.8× 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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85 hospital rates
iThe hospitals that file a Caresource 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 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $179 | $179 | $58 | 32% | — | $121 – $238 |
| 3 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 2 | $147 | $147 | $84 | 57% | — | $63 – $230 |
| 4 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 5 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 6 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 3 | $427 | $510 | $117 | 23% | — | $427 – $676 |
| 7 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 3 | $437 | $517 | $113 | 22% | — | $437 – $676 |
| 8 | Children's Healthcare of Atlanta Atlanta, GA percent of total billed charges · outpatientfrom % of charges | 1 | $676 | $676 | — | — | — | $676 – $676 |
| 9 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $156 | $156 | — | — | — | $156 – $156 |
| 10 | Dayton Osteopathic Hospital Dayton, OH fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 11 | Deaconess Hospital, Inc Newburgh, IN facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 12 | Defiance Hospital Inc Defiance, OH facility · fee schedule · outpatient | 2 | $19 | $19 | $2 | 8% | — | $18 – $21 |
| 13 | Defiance Hospital Inc Defiance, OH professional · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 14 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $32 | $41 | $16 | 38% | — | $27 – $63 |
| 15 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 3 | $122 | $98 | $59 | 60% | — | $17 – $156 |
| 16 | Fort Hamilton Hospital Hamilton, OH fee schedule · outpatient | 1 | $191 | $191 | — | — | — | $191 – $191 |
| 17 | Fostoria Hospital Association Fostoria, OH facility · fee schedule · outpatient | 2 | $21 | $21 | $3 | 16% | — | $18 – $24 |
| 18 | Fostoria Hospital Association Fostoria, OH professional · fee schedule · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 19 | Greene Memorial Hospital Inc Xenia, OH fee schedule · outpatient | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 20 | Greenfield Area Medical Center Greenfield, OH facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 21 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 3 | $51 | $258 | $229 | 89% | — | $51 – $524 |
| 22 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 3 | $51 | $258 | $229 | 89% | — | $51 – $524 |
| 23 | Indiana University Health Bedford Inc. Bedford, IN fee schedule · outpatient | 2 | $51 | $240 | $232 | 97% | — | $51 – $524 |
| 24 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 3 | $51 | $258 | $229 | 89% | — | $51 – $524 |
| 25 | Indiana University Health Frankfort Inc. Frankfort, IN fee schedule · outpatient | 2 | $51 | $240 | $232 | 97% | — | $51 – $524 |
← Payers reporting HCPCS Q4117 · Snapshot 20261111T120946Z-9134e7f7