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Oasis Ultra Tri-Layer Wound Matrix

Indiana 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 $224 · 10th–90th $3$5130%10%10th90th$224Professionalmedian $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
$2.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.57
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.09
Median
$263.03
Typical High
$512.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$12.59
CareSource
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$3.02
Typical High
$4.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89