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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.

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

$15.14

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $15.14 for this service. The price depends on where it is billed: about $15.14 from a physician practice, and about $2.51 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$15.14$2.51 to $15.14
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 $16Professionalmedian $15 · 10th to 90th $3 to $120
$5$10$20$50$100$200facility $3professional $15

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Iowa sits

The same service costs 16.6 times more in Minnesota than in Illinois. 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· 5th of 51

$15.14

MN $41.69IL $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.