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
$6
Average
$120
Median
$129
High
$296
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
111 hospitals; the 90th percentile is 6.1× 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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115 hospital rates
iThe hospitals that file a WellCare 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 | 2 | $135 | $135 | $3 | 2% | — | $131 – $138 |
| 2 | Adventhealth Port Charlotte Port Charlotte, FL fee schedule · outpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 3 | Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 4 | BATON ROUGE GENERAL MEDICAL CENTER BATON ROUGE, LA fee schedule · both | 1 | $120 | $120 | $2 | 1% | — | $118 – $122 |
| 5 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 6 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 7 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 8 | Caldwell Memorial Hospital Lenoir, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 9 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 2 | $123 | $123 | — | — | — | $123 – $123 |
| 10 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 11 | Carle Eureka Hospital Eureka, IL case rate · outpatient | 1 | $133 | $133 | — | — | — | $133 – $133 |
| 12 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 13 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $171 | $171 | — | — | — | $171 – $171 |
| 14 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 15 | Danbury Hospital New Milford, CT fee schedule · outpatient | 1 | $152 | $152 | — | — | — | $152 – $152 |
| 16 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 17 | F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 18 | FLAGET HEALTHCARE, INC Bardstown, KY fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 19 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 20 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $119 | $119 | — | — | — | $119 – $119 |
| 21 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 22 | Garnet Health Medical Center Middletown, NY facility · fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 23 | Garnet Health Medical Center Catskills Harris, NY facility · fee schedule · outpatient | 1 | $159 | $159 | — | — | — | $159 – $159 |
| 24 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 25 | Harborview Medical Center Seattle, WA fee schedule · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
← Payers reporting HCPCS Q4117 · Snapshot 20261111T120946Z-9134e7f7