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XCM Biologic Tissue Matrix

South Dakota 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?

$141

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $141 for this service. The price depends on where it is billed: about $141 from a physician practice, and about $138 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$141$126 to $148
FacilityA hospital or hospital-owned outpatient department$138$138 to $195

How much rates vary

Facilitymedian $138 · 10th to 90th $126 to $245Professionalmedian $141 · 10th to 90th $81 to $182
$100$200facility $138professional $141

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$40.74
Median
$40.74
Typical High
$40.74
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$16.22
Median
$16.22
Typical High
$16.22
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$194.98
Typical High
$245.47
Cigna
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$181.97
Medica
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Midlands
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Midlands
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$141.25

Where South Dakota 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.

South Dakota· 6th of 51

$141

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.