go back

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 October 2026.

How much does Oasis Ultra Tri-Layer Wound Matrix cost?

$10.96

Typical negotiated rate. In Iowa, October 2026.

Insurers have agreed to pay about $10.96 for this service. The price depends on where it is billed: about $10.96 from a physician practice, and about $2.51 from a hospital or other facility.

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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$10.96$2.51 to $126
FacilityA hospital or hospital-owned outpatient department$2.51$2.51 to $15.14

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $21Professionalmedian $11 · 10th to 90th $2 to $191
$10$100$1Kfacility $3professional $11

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
Facility
Modifier
None
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Aetna
Setting
Facility
Modifier
52 · Reduced service
Typical Low
$7.59
Median
$7.59
Typical High
$7.59
Aetna
Setting
Facility
Modifier
53 · Discontinued
Typical Low
$3.02
Median
$3.02
Typical High
$3.02
Aetna
Setting
Facility
Modifier
55 · Aftercare only
Typical Low
$2.24
Median
$2.24
Typical High
$2.24
Aetna
Setting
Facility
Modifier
56 · Pre-op care only
Typical Low
$1.51
Median
$1.51
Typical High
$1.51
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.29
Median
$2.29
Typical High
$15.14
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.15
Median
$1.15
Typical High
$7.59
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.46
Median
$0.46
Typical High
$3.02
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.35
Median
$0.35
Typical High
$2.24
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.23
Median
$0.23
Typical High
$1.51
Cigna
Setting
Facility
Modifier
None
Typical Low
$19.50
Median
$223.87
Typical High
$269.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$9.33
Median
$190.55
Typical High
$190.55
Hally Health
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$2.51
Typical High
$54.95
Medica
Setting
Facility
Modifier
None
Typical Low
$4.17
Median
$15.14
Typical High
$20.89
Medica
Setting
Professional
Modifier
None
Typical Low
$2.45
Median
$2.63
Typical High
$5,370.32
Midlands
Setting
Professional
Modifier
None
Typical Low
$11.22
Median
$190.55
Typical High
$190.55
Midlands
Setting
Facility
Modifier
None
Typical Low
$19.50
Median
$208.93
Typical High
$269.15
Midlands
Setting
Professional
Modifier
None
Typical Low
$11.22
Median
$11.22
Typical High
$15.49
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90
Wellmark
Setting
Facility
Modifier
None
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Wellmark
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$2.51
Typical High
$2.51

Where Iowa 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.

Iowa· 42nd of 51

$10.96

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.