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
$33
Average
$815
Median
$121
High
$20.2k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
29 hospitals; the 90th percentile is 2.8× 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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31 hospital rates
iThe hospitals that file a Tricare 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 | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 2 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 3 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 4 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 5 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 6 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 7 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 8 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 9 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 10 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $35 | $45 | $17 | 38% | — | $30 – $69 |
| 11 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $26 | $33 | $13 | 38% | — | $22 – $50 |
| 12 | Kaleida Health Buffalo, NY fee schedule · outpatient | 1 | $148 | $148 | — | — | — | $148 – $148 |
| 13 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 14 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $84 | $84 | — | — | — | $84 – $84 |
| 15 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 16 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 17 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 18 | McLeod Health Cheraw, SC percent of total billed charges · bothfrom % of charges | 1 | $20.2k | $20.2k | — | — | — | $20.2k – $20.2k |
| 19 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 20 | Northwest Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 21 | Northwest Sahurita Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 22 | Northwest Sahurita Hospital LLC Sahuarita, AZ facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 23 | Orange County Global Medical Center Santa Ana, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 24 | Oro Valley Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 25 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
← Payers reporting HCPCS Q4117 · Snapshot 20261111T120946Z-9134e7f7