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XCM Biologic Tissue Matrix

Massachusetts 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 $174 · 10th–90th $89$5500%10%10th90th$174Professionalmedian $126 · 10th–90th $89$1510%20%40%10th90th$126$50.0$200.0$1.0K$5.0K$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
$89.13
Median
$89.13
Typical High
$89.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$138.04
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$295.12
Typical High
$707.95
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$269.15
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$2,951.21
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$275.42
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$154.88
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$295.12
Typical High
$707.95
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$125.89
Typical High
$134.90