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XCM Biologic Tissue Matrix

New York 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 $129 · 10th–90th $98$2090%50%10th90th$129Professionalmedian $117 · 10th–90th $45$1380%20%40%10th90th$117$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$97.72
Median
$117.49
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$138.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.03
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$229.09
Typical High
$537.03
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$162.18
Typical High
$245.47
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$50,118.72
Typical High
$53,703.18
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$134.90