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XCM Biologic Tissue Matrix

Oregon 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 $155 · 10th–90th $117$2570%20%10th90th$155Professionalmedian $132 · 10th–90th $115$2820%20%10th90th$132$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$125.89
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$169.82
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$263.03
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$251.19
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$251.19
Typical High
$316.23
Providence
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$194.98
Typical High
$269.15
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$125.89
Typical High
$138.04
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89