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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 October 2026.

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

$126

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $204 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$2.51 to $126
FacilityA hospital or hospital-owned outpatient department$204$178 to $257

How much rates vary

Facilitymedian $204 · 10th to 90th $91 to $288Professionalmedian $126 · 10th to 90th $3 to $129
$5$10$20$50$100$200$500facility $204professional $126

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
$2.51
Median
$2.51
Typical High
$117.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$2.51
Typical High
$2.57
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.26
Median
$1.26
Typical High
$1.29
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.50
Median
$0.50
Typical High
$0.51
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.37
Median
$0.37
Typical High
$0.38
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.25
Median
$0.25
Typical High
$0.26
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$72.44
Median
$190.55
Typical High
$281.84
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$128.82
Typical High
$128.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$239.88
Typical High
$302.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$3.24
Typical High
$85.11
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$3.24
Median
$3.24
Typical High
$3.24
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$144.54

Where Illinois 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.

Illinois· 2nd of 51

$126

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.