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Oasis Ultra Tri-Layer Wound Matrix

Hawaii 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?

$12.30

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $12.30 for this service. Most negotiated rates run $12.30 to $12.88.

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.

How much rates vary

Professionalmedian $12 · 10th to 90th $11 to $158
$5$10$20$50$100$200professional $12

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
$2.51
Median
$2.51
Typical High
$2.75
Cigna
Setting
Professional
Modifier
None
Typical Low
$12.30
Median
$12.30
Typical High
$12.30
HMSA
Setting
Professional
Modifier
None
Typical Low
$10.96
Median
$12.88
Typical High
$14.79
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$165.96
Typical High
$204.17
United
Setting
Professional
Modifier
None
Typical Low
$12.30
Median
$12.30
Typical High
$125.89
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$13.18
Median
$13.18
Typical High
$213.80

Where Hawaii 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.

Hawaii· 39th of 51

$12.30

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.