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Oasis Ultra Tri-Layer Wound Matrix

Washington, DC 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 $3 · 10th–90th $3$2630%50%90th$3Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$5.0$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. 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
$2.57
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$12.30
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$263.03
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$14.45
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$125.89
Typical High
$158.49