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Oasis Ultra Tri-Layer Wound Matrix

Kansas 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?

$15.85

Typical negotiated rate. In Kansas, October 2026.

Insurers have agreed to pay about $15.85 for this service. The price depends on where it is billed: about $15.14 from a physician practice, and about $170 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$15.14$2.51 to $126
FacilityA hospital or hospital-owned outpatient department$170$15.14 to $170

How much rates vary

Facilitymedian $170 · 10th to 90th $14 to $468Professionalmedian $15 · 10th to 90th $2 to $5,370
$10$100$1Kfacility $170professional $15

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
$3.39
Median
$15.14
Typical High
$15.14
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$3.39
Typical High
$15.14
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.26
Median
$1.70
Typical High
$7.59
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.50
Median
$0.68
Typical High
$3.02
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.37
Median
$0.51
Typical High
$2.24
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.25
Median
$0.34
Typical High
$1.51
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$169.82
Typical High
$467.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$3.47
Median
$15.14
Typical High
$15.14
Medica
Setting
Professional
Modifier
None
Typical Low
$2.45
Median
$2.45
Typical High
$5,370.32
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Kansas 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.

Kansas· 25th of 51

$15.85

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.