go back

Oasis Ultra Tri-Layer Wound Matrix

Alaska 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 $5 · 10th–90th $3$1780%20%10th90th$5Professionalmedian $42 · 10th–90th $3$4070%20%10th90th$42$5.0$20.0$100.0$500.0$2.0K

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
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$4.57
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$4.57
Typical High
$158.49
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$512.86
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.72
Median
$23.99
Typical High
$52.48
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$16.60
Typical High
$18.20
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$5.13
Typical High
$302.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$190.55
Typical High
$380.19