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XCM Biologic Tissue Matrix

Nebraska 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 $191 · 10th–90th $115$3090%10%10th90th$191Professionalmedian $117 · 10th–90th $81$1550%50%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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$147.91
Typical High
$181.97
Medica
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$162.18
Medica
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$141.25