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XCM Biologic Tissue Matrix

Colorado 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 $135 · 10th–90th $81$2240%10%20%10th90th$135Professionalmedian $126 · 10th–90th $81$1350%20%40%10th90th$126$50.0$100.0$200.0$500.0$1.0K

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
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$134.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$109.65
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$204.17
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$213.80
Select Health
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$208.93
Typical High
$281.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89