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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 October 2026.

How much does Oasis Ultra Tri-Layer Wound Matrix cost?

$16.60

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $16.60 for this service. The price depends on where it is billed: about $15.14 from a physician practice, and about $186 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$15.14$4.57 to $191
FacilityA hospital or hospital-owned outpatient department$186$23.99 to $316

How much rates vary

Facilitymedian $186 · 10th to 90th $5 to $550Professionalmedian $15 · 10th to 90th $5 to $339
$5$20$100$500facility $186professional $15

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
$4.57
Median
$4.57
Typical High
$4.57
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.57
Median
$4.57
Typical High
$4.57
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.29
Median
$2.29
Typical High
$2.29
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.51
Median
$0.91
Typical High
$0.91
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.38
Median
$0.69
Typical High
$0.69
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.26
Median
$0.46
Typical High
$0.46
Cigna
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$316.23
Typical High
$933.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
None
Typical Low
$2.51
Median
$4.57
Typical High
$6.61
Moda Health
Setting
Professional
Modifier
None
Typical Low
$4.57
Median
$4.57
Typical High
$416.87
Moda Health
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$2.29
Median
$2.29
Typical High
$2.29
Moda Health
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.91
Median
$0.91
Typical High
$0.91
Moda Health
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.69
Median
$0.69
Typical High
$0.69
Moda Health
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.46
Median
$0.46
Typical High
$0.46
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$20.89
Median
$30.20
Typical High
$52.48
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$14.13
Median
$15.14
Typical High
$18.20
Providence
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$302.00
Typical High
$933.25
Providence
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$60.26
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$190.55
Typical High
$354.81

Where Alaska sits

The same service costs 50.1 times more in Massachusetts than in Indiana. 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.

Alaska· 24th of 51

$16.60

MA $126IN $2.51

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.