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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.

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

$15.85

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $15.85 for this service. The price depends on where it is billed: about $16.22 from a physician practice, and about $15.14 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$16.22$2.51 to $123
FacilityA hospital or hospital-owned outpatient department$15.14$2.57 to $85.11

How much rates vary

Facilitymedian $15 · 10th to 90th $3 to $209Professionalmedian $16 · 10th to 90th $3 to $132
$5$10$20$50$100$200facility $15professional $16

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
$2.57
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

Where Missouri 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.

Missouri· 3rd of 51

$15.85

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.