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XCM Biologic Tissue Matrix

Alaska rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated October 2026.

How much does XCM Biologic Tissue Matrix cost?

$132

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $132 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $257 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$132$132 to $195
FacilityA hospital or hospital-owned outpatient department$257$186 to $398

How much rates vary

Facilitymedian $257 · 10th to 90th $132 to $550Professionalmedian $132 · 10th to 90th $126 to $339
$100$200$500$1Kfacility $257professional $132

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
Aetna
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$131.83
Typical High
$131.83
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$64.57
Median
$66.07
Typical High
$66.07
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$25.70
Median
$26.30
Typical High
$26.30
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.05
Median
$19.50
Typical High
$19.50
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$12.88
Median
$13.18
Typical High
$13.18
Cigna
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$316.23
Typical High
$933.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$181.97
Typical High
$186.21
Moda Health
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$131.83
Typical High
$416.87
Moda Health
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Moda Health
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$26.30
Median
$26.30
Typical High
$26.30
Moda Health
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Moda Health
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$13.18
Median
$13.18
Typical High
$13.18
Providence
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$302.00
Typical High
$933.25
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$190.55
Typical High
$346.74

Where Alaska sits

The same service costs 5.5 times more in North Dakota than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Alaska· 9th of 51

$132

ND $224KY $40.74

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.