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XCM Biologic Tissue Matrix

Pennsylvania rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated October 2026.

How much does XCM Biologic Tissue Matrix cost?

$126

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $120 from a physician practice, and about $178 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$120$115 to $126
FacilityA hospital or hospital-owned outpatient department$178$145 to $214

How much rates vary

Facilitymedian $178 · 10th to 90th $126 to $468Professionalmedian $120 · 10th to 90th $93 to $126
$100$200$500facility $178professional $120

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$117.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$46.77
Median
$58.88
Typical High
$58.88
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$18.62
Median
$23.44
Typical High
$23.44
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$14.13
Median
$17.38
Typical High
$17.38
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$9.33
Median
$11.75
Typical High
$11.75
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$234.42
Typical High
$275.42
Geisinger
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$147.91
Typical High
$208.93
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$117.49
Typical High
$117.49
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$46.77
Median
$58.88
Typical High
$58.88
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$18.62
Median
$23.44
Typical High
$23.44
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$14.13
Median
$17.38
Typical High
$17.38
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$9.33
Median
$11.75
Typical High
$11.75
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$134.90

Where Pennsylvania sits

The same service costs 5.5 times more in North Dakota 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.

Pennsylvania· 35th of 51

$126

ND $224KY $40.74

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.