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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 October 2026.

How much does XCM Biologic Tissue Matrix cost?

$123

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $120 from a physician practice, and about $135 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$120$115 to $126
FacilityA hospital or hospital-owned outpatient department$135$126 to $316

How much rates vary

Facilitymedian $135 · 10th to 90th $81 to $347Professionalmedian $120 · 10th to 90th $81 to $148
$100$200facility $135professional $120

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$40.74
Median
$40.74
Typical High
$40.74
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$16.22
Median
$16.22
Typical High
$16.22
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
BCBS
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
BCBS
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$147.91
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$134.90
Typical High
$346.74
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$117.49
Typical High
$154.88
Health Alliance Plan
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Health Alliance Plan
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$22.91
Median
$22.91
Typical High
$23.44
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$11.48
Median
$11.48
Typical High
$11.75
Priority Health
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90

Where Michigan sits

The same service costs 5.5 times more in North Dakota 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.

Michigan· 45th of 51

$123

ND $224KY $40.74

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.