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XCM Biologic Tissue Matrix

North Carolina 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 $126 · 10th–90th $117$2570%20%10th90th$126Professionalmedian $117 · 10th–90th $89$1290%20%10th90th$117$50.0$100.0$200.0$500.0

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
$131.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$281.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$128.82
Typical High
$204.17
Medcost
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$208.93
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69