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XCM Biologic Tissue Matrix

New Mexico 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 $141 · 10th–90th $81$2750%10%20%10th90th$141Professionalmedian $123 · 10th–90th $72$1350%20%40%10th90th$123$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
$120.23
Median
$120.23
Typical High
$120.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$120.23
Typical High
$134.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$60.26
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$138.04
Typical High
$281.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89