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Oasis Ultra Tri-Layer Wound Matrix

Michigan 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?

$3.24

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $3.24 for this service. The price depends on where it is billed: about $3.24 from a physician practice, and about $7.24 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$3.24$2.57 to $120
FacilityA hospital or hospital-owned outpatient department$7.24$3.72 to $135

How much rates vary

Facilitymedian $7 · 10th to 90th $3 to $135Professionalmedian $3 · 10th to 90th $3 to $126
$5$10$20$50$100facility $7professional $3

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
$2.57
Median
$2.57
Typical High
$2.57
Aetna
Setting
Professional
Modifier
None
Typical Low
$2.57
Median
$2.57
Typical High
$2.57
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.51
Median
$0.51
Typical High
$0.52
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.38
Median
$0.38
Typical High
$0.39
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.26
Median
$0.26
Typical High
$0.26
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$20.42
Median
$120.23
Typical High
$120.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$3.72
Median
$14.45
Typical High
$134.90
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$2.51
Median
$2.57
Typical High
$3.55
Health Alliance Plan
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$1.29
Median
$1.29
Typical High
$1.29
Health Alliance Plan
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$0.51
Median
$0.51
Typical High
$0.51
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.38
Median
$0.38
Typical High
$0.38
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.26
Median
$0.26
Typical High
$0.26
Priority Health
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90

Where Michigan 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.

Michigan· 47th of 51

$3.24

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.