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Oasis Ultra Tri-Layer Wound Matrix

Massachusetts 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 $17 · 10th–90th $8$2340%20%10th90th$17Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$8.13
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$125.89
Typical High
$707.95
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$125.89
Typical High
$223.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$28.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$229.09
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$1,995.26
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$181.97
Typical High
$275.42
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$4.57
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$125.89
Typical High
$707.95
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$125.89
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$10.23
Typical High
$125.89