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Oasis Ultra Tri-Layer Wound Matrix

Missouri 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 $15 · 10th–90th $3$2090%20%10th90th$15Professionalmedian $16 · 10th–90th $3$1320%20%10th90th$16$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
$2.57
Typical High
$15.85
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$15.85
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$109.65
Typical High
$134.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$3.55
Typical High
$16.60
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.40
Median
$2.45
Typical High
$5,370.32
United
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$102.33
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$125.89
Typical High
$125.89