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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.

Facilitymedian $102 · 10th–90th $56$2880%5%10%10th90th$102Professionalmedian $126 · 10th–90th $81$1380%20%40%10th90th$126$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

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