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
HYALOMATRIX 5X5 254X-331
Glendale, CA
See all hospitals reporting HCPCS Q4117 →Price type
Dignity Community Care’s median price of $497 is 349% above the median hospital's median price ($111), higher than 93% of the 1,075 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: 9 payers, 31 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 | Anthem medicaid|all plans fee schedule · outpatient | $11 | $11 | — | — | — | $11 – $11 |
| 2 | Molina medicaid|all plans fee schedule · outpatient | $12 | $12 | — | — | — | $12 – $12 |
| 3 | Kaiser medicaid|< 21 fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 4 | Kaiser medicaid|> 21 fee schedule · outpatient | $13 | $13 | — | — | — | $13 – $13 |
| 5 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $49 | $49 | — | — | — | $49 – $49 |
| 6 | UnitedHealthcare commercial|navigate fee schedule · outpatient | $49 | $49 | — | — | — | $49 – $49 |
| 7 | UnitedHealthcare commercial|options ppo fee schedule · outpatient | $49 | $49 | — | — | — | $49 – $49 |
| 8 | UnitedHealthcare commercial|ppo fee schedule · outpatient | $49 | $49 | — | — | — | $49 – $49 |
| 9 | Anthem commercial|mcs fee schedule · outpatient | $194 | $194 | — | — | — | $194 – $194 |
| 10 | Anthem commercial|non-mcs fee schedule · outpatient | $194 | $194 | — | — | — | $194 – $194 |
| 11 | Molina medicaid|all plans fee schedule · inpatient | $736 | $1.2k | $1.1k | 91% | — | $173 – $3.1k |
| 12 | Anthem medicaid|all plans fee schedule · inpatient | $800 | $1.4k | $1.2k | 91% | — | $188 – $3.4k |
| 13 | Cigna commercial|all other plans fee schedule · inpatient | $960 | $1.6k | $1.5k | 91% | — | $225 – $4.1k |
| 14 | Cigna commercial|ppo fee schedule · inpatient | $960 | $1.6k | $1.5k | 91% | — | $225 – $4.1k |
| 15 | Kaiser commercial|all plans fee schedule · inpatient | $1.8k | $3.0k | $2.8k | 91% | — | $420 – $7.6k |
| 16 | Kaiser commercial|all plans fee schedule · outpatient | $1.8k | $3.0k | $2.8k | 91% | — | $420 – $7.6k |
| 17 | Blue Cross Blue Shield commercial|magellan fee schedule · inpatient | $1.9k | $3.2k | $3.0k | 91% | — | $450 – $8.1k |
| 18 | Blue Cross Blue Shield commercial|magellan fee schedule · outpatient | $1.9k | $3.2k | $3.0k | 91% | — | $450 – $8.1k |
| 19 | First Health commercial|all plans fee schedule · inpatient | $2.1k | $3.5k | $3.2k | 91% | — | $488 – $8.8k |
| 20 | First Health commercial|all plans fee schedule · outpatient | $2.1k | $3.5k | $3.2k | 91% | — | $488 – $8.8k |
| 21 | Cigna commercial|all other plans fee schedule · outpatient | $2.2k | $3.7k | $3.3k | 91% | — | $510 – $9.2k |
| 22 | Cigna commercial|ppo fee schedule · outpatient | $2.2k | $3.7k | $3.3k | 91% | — | $510 – $9.2k |
| 23 | Blue Cross Blue Shield commercial|exchange fee schedule · inpatient | $2.4k | $4.1k | $3.7k | 91% | — | $563 – $10.2k |
| 24 | MultiPlan commercial|all plans fee schedule · inpatient | $2.6k | $4.3k | $3.9k | 91% | — | $600 – $10.9k |
| 25 | MultiPlan commercial|all plans fee schedule · outpatient | $2.6k | $4.3k | $3.9k | 91% | — | $600 – $10.9k |
Last updated: Feb 28, 2026
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