go back

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 July 2026.

Professionalmedian $11 · 10th–90th $3$160%20%40%10th90th$11$5.0$10.0$20.0$50.0$100.0$200.0

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
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.75
Cigna
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$12.88
Typical High
$125.89
HMSA
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.88
Typical High
$14.79
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$125.89
Typical High
$125.89