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Oasis Ultra Tri-Layer Wound Matrix

Illinois 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 $191 · 10th–90th $3$2570%10%10th90th$191Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$2.0$10.0$50.0$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
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.02
BCBS
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$194.98
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$40.74
Typical High
$85.11
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$3.24
Median
$3.24
Typical High
$3.24
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$125.89
Typical High
$125.89