go back

XCM Biologic Tissue Matrix

Wyoming 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 Wyoming, October 2026.

Insurers have agreed to pay about $126 for this service. Most negotiated rates run $126 to $182.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $302 · 10th to 90th $126 to $479Professionalmedian $126 · 10th to 90th $126 to $182
$100$200$500facility $302professional $126

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
$117.49
Median
$125.89
Typical High
$125.89
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$58.88
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$23.44
Median
$25.70
Typical High
$25.70
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$17.38
Median
$19.05
Typical High
$19.05
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$11.75
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$302.00
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Wyoming 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.

Wyoming· 15th 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.