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XCM Biologic Tissue Matrix

Georgia 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 $126$3390%50%10th90th$135Professionalmedian $117 · 10th–90th $81$1350%20%40%10th90th$117$0.0$0.1$0.5$2.0$10.0$50.0$200.0

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
$125.89
Median
$125.89
Typical High
$125.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$114.82
Typical High
$134.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$117.49
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$234.42
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$186.21
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$245.47
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90