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XCM Biologic Tissue Matrix

Texas 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 $145 · 10th–90th $115$7080%20%10th90th$145Professionalmedian $126 · 10th–90th $98$1350%20%40%10th90th$126$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$125.89
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$134.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$120.23
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$316.23
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$138.04
Typical High
$263.03
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$234.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$32.36
Typical High
$50.12
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$302.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$263.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$6.31
Median
$120.23
Typical High
$169.82