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Oasis Ultra Tri-Layer Wound Matrix

Iowa 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$160%50%90th$3Professionalmedian $15 · 10th–90th $3$1200%20%10th90th$15$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$15.14
Median
$15.14
Typical High
$15.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$15.14
Typical High
$15.85
Cigna
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$223.87
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$10.96
Typical High
$21.38
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$25.12
Typical High
$54.95
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$10.96
Typical High
$63.10
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$15.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$10.96
Typical High
$13.18
Midlands
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$208.93
Typical High
$269.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$15.49
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$114.82
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$134.90
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$2.51
Typical High
$2.51