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Oasis Ultra Tri-Layer Wound Matrix

Florida 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 $126 · 10th–90th $3$154,8820%20%10th90th$126Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$2.0$20.0$200.0$2.0K$20.0K$200.0K

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
AvMed
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$107.15
Typical High
$125.89
AvMed
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$97.72
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$102,329.30
Typical High
$208,929.61
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$93.33
Typical High
$141.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$162.18
Typical High
$251.19
United
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$125.89
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$134.90
Typical High
$134.90