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Virginia rates for HCPCS Q4142

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

Facilitymedian $135 · 10th–90th $117–$2400%50%10th90th$135Professionalmedian $126 · 10th–90th $87–$1860%20%10th90th$126$2.0$10.0$50.0$200.0

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $134.90 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $120.23 / $134.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $134.90 / $229.09
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $128.82