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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.

Facilitymedian $182 · 10th–90th $126$7080%20%10th90th$182Professionalmedian $126 · 10th–90th $40$1780%20%40%10th90th$126$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$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