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Oasis Ultra Tri-Layer Wound Matrix

Maryland 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 $3 · 10th–90th $3$130%50%90th$3Professionalmedian $3 · 10th–90th $3$1260%50%10th90th$3$5.0$10.0$20.0$50.0$100.0$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. Small sample; interpret with caution. 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
$10.23
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$138.04
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$16.22
Typical High
$16.22
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$125.89
Typical High
$134.90
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$162.18
Typical High
$204.17