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
$20
Average
$72
Median
$48
High
$265
Each hospital's average Medical Mutual rate, under the methodology and billing class chosen below.
54 hospitals; the 90th percentile is 6.8× 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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67 hospital rates
iThe hospitals that file a Medical Mutual 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 Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 2 | Bay Park Community Hospital Oregon, OH facility · other · outpatient | 1 | $466 | $466 | — | — | — | $466 – $466 |
| 3 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 4 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 5 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $19 | $20 | $4 | 18% | — | $16 – $25 |
| 6 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $19 | $20 | $4 | 18% | — | $16 – $25 |
| 7 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $41 | $43 | $8 | 18% | — | $34 – $53 |
| 8 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $49 | $52 | $10 | 18% | — | $42 – $64 |
| 9 | Defiance Hospital Inc Defiance, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 10 | Defiance Hospital Inc Defiance, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 11 | Defiance Hospital Inc Defiance, OH professional · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 12 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $34 | $42 | $16 | 38% | — | $28 – $65 |
| 13 | Fairfield Medical Center 401 N Ewing St facility · fee schedule · outpatient | 1 | $118 | $118 | — | — | — | $118 – $118 |
| 14 | Fairfield Medical Center 401 N Ewing St facility · percent of total billed charges · inpatientfrom % of charges | 2 | $21 | $21 | $4 | 20% | — | $17 – $25 |
| 15 | Fairfield Medical Center 401 N Ewing St facility · percent of total billed charges · outpatientfrom % of charges | 2 | $21 | $21 | $4 | 20% | — | $17 – $25 |
| 16 | Fostoria Hospital Association Fostoria, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $35 | $35 | — | — | — | $35 – $35 |
| 17 | Fostoria Hospital Association Fostoria, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $35 | $35 | — | — | — | $35 – $35 |
| 18 | Fostoria Hospital Association Fostoria, OH professional · fee schedule · outpatient | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 19 | McCullough-Hyde Memorial Hospital, Inc. Oxford, OH facility · fee schedule · outpatient | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 20 | Memorial Hospital Fremont, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $29 | $29 | — | — | — | $29 – $29 |
| 21 | Memorial Hospital Fremont, OH professional · fee schedule · outpatient | 1 | $29 | $29 | — | — | — | $29 – $29 |
| 22 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $26 | $33 | $13 | 38% | — | $22 – $51 |
| 23 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $30 | $37 | $14 | 38% | — | $25 – $58 |
| 24 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $28 | $35 | $13 | 38% | — | $23 – $54 |
| 25 | Mercy Health Services-Iowa Corp. Mason City, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $29 | $30 | $6 | 18% | — | $24 – $38 |
← Payers reporting HCPCS Q4117 · Snapshot 20261111T120946Z-9134e7f7