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XCM Biologic Tissue Matrix

Michigan 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 $117 · 10th–90th $102$2090%50%10th90th$117Professionalmedian $126 · 10th–90th $81$1410%20%40%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. 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
$138.04
BCBS
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$134.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$131.83
Typical High
$346.74
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$120.23
Typical High
$158.49
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$154.88
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$125.89