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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.

Facilitymedian $23 · 10th–90th $3$2570%10%10th90th$23Professionalmedian $102 · 10th–90th $3$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$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