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XCM Biologic Tissue Matrix

Oklahoma 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 $115 · 10th–90th $102$2090%50%10th90th$115Professionalmedian $126 · 10th–90th $76$1320%50%10th90th$126$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
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$120.23
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$331.13
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$100.00
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89