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Oasis Ultra Tri-Layer Wound Matrix

Nationwide rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

Facilitymedian $15 · 10th–90th $3$2240%10%20%10th90th$15Professionalmedian $3 · 10th–90th $3$1260%50%10th90th$3$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
$2.51
Median
$2.51
Typical High
$15.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$16.22
Typical High
$74.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$12.59
Typical High
$26.92
Cigna
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$173.78
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$125.89
Typical High
$125.89