go back

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.

How much does XCM Biologic Tissue Matrix cost?

$117

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $117 from a physician practice, and about $129 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$117$44.67 to $129
FacilityA hospital or hospital-owned outpatient department$129$117 to $145

How much rates vary

Facilitymedian $129 · 10th to 90th $98 to $209Professionalmedian $117 · 10th to 90th $45 to $138
$0.1$1$10$100facility $129professional $117

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where New York sits

The same service costs 1.7 times more in Alaska 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.

New York· 42nd of 51

$117

AK $141KY $81.28

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.