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XCM Biologic Tissue Matrix

California 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 California, 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 $182 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 9 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$97.72 to $132
FacilityA hospital or hospital-owned outpatient department$182$145 to $251

How much rates vary

Facilitymedian $182 · 10th to 90th $126 to $708Professionalmedian $126 · 10th to 90th $40 to $178
$50$100$200$500facility $182professional $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
$128.82
Median
$128.82
Typical High
$151.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$151.36
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$125.89
Typical High
$151.36
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$199.53
Typical High
$239.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$173.78
Typical High
$269.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Providence
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$177.83
Typical High
$257.04
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97

Where California 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.

California· 22nd 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.