HCPCS Q4117

Hyalomatrix, per square centimeter (add-on, list separately in addition to primary procedure)

Current codeSkin Substitute Products31 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Prices for HCPCS Q4117 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
Deaconess Medical CenterSpokaneFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
EvergreenHealth Medical CenterKirkland	—	$157	$196
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01	—	$383 – $5,536	$547 – $7,908
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01	—	$538 – $7,524	$769 – $10,748
Providence Centralia HospitalCentraliaFile dated 2026-04-01	—	$570 – $12,579	$1,096 – $24,191
Providence Holy Family HospitalSpokaneFile dated 2026-04-01	—	$538 – $7,524	$769 – $10,748
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01	—	$509 – $7,196	$728 – $10,280
Providence Regional Medical Center EverettEverettFile dated 2026-04-01	—	$630 – $10,243	$1,212 – $19,698
Providence St Joseph HospitalChewelahFile dated 2026-04-01	—	$509 – $7,196	$728 – $10,280
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01	—	$443 – $6,492	$633 – $9,274
Providence St Peter HospitalOlympiaFile dated 2026-04-01	—	$570 – $12,579	$1,096 – $24,191
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01	—	$391 – $7,264	$814 – $15,133
Swedish IssaquahIssaquahFile dated 2026-04-01	—	$391 – $7,264	$814 – $15,133
Swedish Medical CenterSeattleFile dated 2026-04-01	—	$391 – $7,264	$814 – $15,133
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01	—	$391 – $7,264	$814 – $15,133
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27	—	$410 – $6,944	$1,025 – $17,359
Virginia Mason Medical CenterSeattle	—	$21.93 – $47.94	$43.00 – $94.00

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Doctor's fee, Seattle (King County): $156 in an office; $156 in a hospital or surgery center
Doctor's fee, rest of Washington: $134 in an office; $134 in a hospital or surgery center
Hospital outpatient payment (national): $127 (APC 6001)
Surgery center payment (national): $127