go back

Oasis Ultra Tri-Layer Wound Matrix

Colorado 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 $4 · 10th–90th $3$1910%20%40%10th90th$4Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$2.0$10.0$50.0$200.0$1.0K

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
$2.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.95
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$144.54
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.75
Typical High
$17.38
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$190.55
Typical High
$213.80
Select Health
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$208.93
Typical High
$281.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$208.93
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89