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
$0
Average
$166
Median
$122
High
$5.4k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
189 hospitals; the 90th percentile is 22.3× 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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251 hospital rates
iThe hospitals that file a Molina 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 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 2 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 3 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $261 | $261 | — | — | — | $261 – $261 |
| 4 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $181 | $181 | $62 | 34% | — | $119 – $244 |
| 5 | Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient | 1 | $92 | $92 | — | — | — | $92 – $92 |
| 6 | BAKERSFIELD MEMORIAL HOSPITAL Bakersfield, CA fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 7 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 2 | $192 | $192 | $63 | 33% | — | $129 – $255 |
| 8 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 9 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $196 | $196 | $69 | 35% | — | $127 – $264 |
| 11 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 12 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $264 | $264 | — | — | — | $264 – $264 |
| 13 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 14 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · inpatient | 1 | $736 | $1.2k | $1.1k | 91% | — | $173 – $3.1k |
| 15 | COMMUNITY HOSPITAL OF SAN BERNARDINO San Bernardino, CA fee schedule · outpatient | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 16 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 17 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $35 | $37 | $7 | 18% | — | $29 – $46 |
| 18 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 19 | Corewell Health Farmington Hills Hospital Farmington Hills, MI facility · fee schedule · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 20 | Corona Regional Medical Center Corona, CA fee schedule · both | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 21 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $97 | $97 | $30 | 31% | — | $66 – $127 |
| 22 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 2 | $116 | $116 | — | — | — | $116 – $116 |
| 23 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $97 | $97 | $30 | 31% | — | $66 – $127 |
| 24 | Covenant Medical Center Inc Saginaw, MI professional · fee schedule · both | 2 | $116 | $116 | — | — | — | $116 – $116 |
| 25 | DIGNITY COMMUNITY CARE Glendale, CA fee schedule · inpatient | 1 | $736 | $1.2k | $1.1k | 91% | — | $173 – $3.1k |
← Payers reporting HCPCS Q4117 · Snapshot 20261111T120946Z-9134e7f7