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Oasis Ultra Tri-Layer Wound Matrix

Arizona 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?

$115

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $107 from a physician practice, and about $145 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$107$2.75 to $126
FacilityA hospital or hospital-owned outpatient department$145$70.79 to $224

How much rates vary

Facilitymedian $145 · 10th to 90th $49 to $275Professionalmedian $107 · 10th to 90th $2 to $234
$10$100$1Kfacility $145professional $107

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.69
Median
$2.75
Typical High
$2.75
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.35
Median
$1.38
Typical High
$1.38
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.54
Median
$0.55
Typical High
$0.55
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.41
Median
$0.41
Typical High
$0.41
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.27
Median
$0.27
Typical High
$0.27
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$48.98
Median
$117.49
Typical High
$309.03
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$100.00
Typical High
$223.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$263.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$2.45
Median
$3.02
Typical High
$75.86
Medica
Setting
Professional
Modifier
None
Typical Low
$2.45
Median
$2.45
Typical High
$5,370.32
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona 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.

Arizona· 20th of 51

$115

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.