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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 October 2026.

How much does XCM Biologic Tissue Matrix cost?

$126

Typical negotiated rate. In Arizona, October 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 $148 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$126$81.28 to $126
FacilityA hospital or hospital-owned outpatient department$148$81.28 to $224

How much rates vary

Facilitymedian $148 · 10th to 90th $49 to $275Professionalmedian $126 · 10th to 90th $81 to $126
$50$100$200facility $148professional $126

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$97.72
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$40.74
Median
$40.74
Typical High
$47.86
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$16.22
Median
$16.22
Typical High
$19.50
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$12.02
Median
$12.02
Typical High
$14.45
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$8.13
Median
$8.13
Typical High
$9.77
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$48.98
Median
$117.49
Typical High
$309.03
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$97.72
Typical High
$218.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$263.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$89.13
Typical High
$114.82
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona 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.

Arizona· 30th of 51

$126

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.