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
HYALOMTRX10X20 1605X-2087
Chandler, AZ
See all hospitals reporting HCPCS Q4117 →Price type
Dignity Community Care’s median price of $195 is 75% above the median hospital's median price ($111), higher than 81% of the 1,079 hospitals reporting HCPCS Q4117. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 16 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare medicaid|all plans fee schedule · outpatient | $29 | $29 | — | — | — | $29 – $29 |
| 2 | Cigna commercial|exchange fee schedule · outpatient | $30 | $30 | — | — | — | $30 – $30 |
| 3 | Cigna commercial|localplus surefit fee schedule · outpatient | $32 | $32 | — | — | — | $32 – $32 |
| 4 | Cigna commercial|all other plans fee schedule · outpatient | $43 | $43 | — | — | — | $43 – $43 |
| 5 | Blue Cross Blue Shield commercial|maricopafocus fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 6 | Blue Cross Blue Shield commercial|neighborhood fee schedule · outpatient | $68 | $68 | — | — | — | $68 – $68 |
| 7 | Blue Cross Blue Shield commercial|all other plans fee schedule · outpatient | $91 | $91 | — | — | — | $91 – $91 |
| 8 | Blue Cross Blue Shield commercial|workers comp fee schedule · outpatient | $135 | $135 | — | — | — | $135 – $135 |
| 9 | UnitedHealthcare commercial|dignityhealthemployee fee schedule · outpatient | $645 | $923 | $828 | 90% | — | $161 – $2.2k |
| 10 | Aetna commercial|all other plans fee schedule · outpatient | $784 | $1.1k | $1.0k | 90% | — | $195 – $2.7k |
| 11 | Aetna commercial|hmo fee schedule · outpatient | $784 | $1.1k | $1.0k | 90% | — | $195 – $2.7k |
| 12 | Aetna commercial|ppo fee schedule · outpatient | $784 | $1.1k | $1.0k | 90% | — | $195 – $2.7k |
| 13 | First Health commercial|all plans fee schedule · inpatient | $2.5k | $3.6k | $3.2k | 90% | — | $619 – $8.6k |
| 14 | First Health commercial|all plans fee schedule · outpatient | $2.5k | $3.6k | $3.2k | 90% | — | $619 – $8.6k |
| 15 | MultiPlan commercial|all plans fee schedule · inpatient | $3.9k | $5.5k | $5.0k | 90% | — | $963 – $13.4k |
| 16 | MultiPlan commercial|all plans fee schedule · outpatient | $3.9k | $5.5k | $5.0k | 90% | — | $963 – $13.4k |
Last updated: Feb 28, 2026
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