go back

XCM Biologic Tissue Matrix

Maryland 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 $138 · 10th–90th $126$1380%50%100%10th$138Professionalmedian $126 · 10th–90th $81$1380%50%10th90th$126$50.0$100.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$151.36
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$134.90
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$204.17