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XCM Biologic Tissue Matrix

South Carolina 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 $126 · 10th–90th $115$2450%20%10th90th$126Professionalmedian $117 · 10th–90th $81$1290%20%40%10th90th$117$50.0$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
$114.82
Median
$114.82
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$117.49
Typical High
$128.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$128.82
Typical High
$245.47
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89