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XCM Biologic Tissue Matrix

Arizona rates for HCPCS Q4142

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

Rates data updated July 2026.

How much does XCM Biologic Tissue Matrix cost?

$126

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $102 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$115 to $129
FacilityA hospital or hospital-owned outpatient department$102$75.86 to $195

How much rates vary

Facilitymedian $102 · 10th to 90th $56 to $288Professionalmedian $126 · 10th to 90th $81 to $138
$50$100$200facility $102professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$134.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$97.72
Typical High
$331.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$134.90
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$89.13
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona sits

The same service costs 1.7 times more in Alaska 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.

Arizona· 25th of 51

$126

AK $141KY $81.28

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.