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Oasis Ultra Tri-Layer Wound Matrix

Louisiana 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?

$107

Typical negotiated rate. In Louisiana, October 2026.

Insurers have agreed to pay about $107 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $2.63 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$126$2.57 to $126
FacilityA hospital or hospital-owned outpatient department$2.63$2.63 to $10.00

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $224Professionalmedian $126 · 10th to 90th $3 to $126
$5$10$20$50$100$200facility $3professional $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
$2.57
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
$0.38
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 Louisiana
Setting
Facility
Modifier
None
Typical Low
$2.63
Median
$2.63
Typical High
$2.63
BCBS Louisiana
Setting
Professional
Modifier
None
Typical Low
$2.63
Median
$2.63
Typical High
$2.63
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$223.87
Typical High
$338.84
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$125.89
Typical High
$125.89

Where Louisiana 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.

Louisiana· 22nd of 51

$107

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.