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Oasis Ultra Tri-Layer Wound Matrix

Minnesota 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.

How much does Oasis Ultra Tri-Layer Wound Matrix cost?

$41.69

Typical negotiated rate. In Minnesota, July 2026.

Insurers have agreed to pay about $41.69 for this service. The price depends on where it is billed: about $102 from a physician practice, and about $22.91 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$102$7.76 to $126
FacilityA hospital or hospital-owned outpatient department$22.91$9.12 to $29.51

How much rates vary

Facilitymedian $23 · 10th to 90th $3 to $257Professionalmedian $102 · 10th to 90th $3 to $126
$2$5$10$20$50$100$200facility $23professional $102

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$15.49
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$24.55
Typical High
$33.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$10.96
Typical High
$11.75
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$23.99
Typical High
$34.67
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$12.59
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$6.76
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$9.12
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$125.89
Typical High
$239.88

Where Minnesota sits

The same service costs 16.6 times more in Minnesota than in Illinois. 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.

Minnesota· 1st of 51

$41.69

MN $41.69IL $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.