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XCM Biologic Tissue Matrix

Indiana 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 $245 · 10th–90th $115$5130%10%10th90th$245Professionalmedian $117 · 10th–90th $41$1290%20%10th90th$117$50.0$100.0$200.0$500.0

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$128.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$275.42
Typical High
$512.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$40.74
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89