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XCM Biologic Tissue Matrix

Virginia 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 Virginia, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $224 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$126$126 to $126
FacilityA hospital or hospital-owned outpatient department$224$141 to $263

How much rates vary

Facilitymedian $224 · 10th to 90th $126 to $316Professionalmedian $126 · 10th to 90th $126 to $135
$100$200facility $224professional $126

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
$125.89
Median
$125.89
Typical High
$134.90
Aetna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$63.10
Median
$63.10
Typical High
$67.61
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$25.12
Median
$25.12
Typical High
$27.54
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$18.62
Median
$18.62
Typical High
$20.42
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$12.59
Median
$12.59
Typical High
$13.49
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$223.87
Typical High
$331.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$151.36
Typical High
$194.98
Medcost
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$190.55
Medcost
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$128.82

Where Virginia 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.

Virginia· 41st 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.