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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.

How much does XCM Biologic Tissue Matrix cost?

$117

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $117 from a physician practice, and about $245 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 4 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$117$75.86 to $126
FacilityA hospital or hospital-owned outpatient department$245$126 to $380

How much rates vary

Facilitymedian $245 · 10th to 90th $115 to $513Professionalmedian $117 · 10th to 90th $41 to $129
$50$100$200$500facility $245professional $117

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
$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

Where Indiana 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.

Indiana· 43rd of 51

$117

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.