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Oasis Ultra Tri-Layer Wound Matrix

Montana 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?

$9.55

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $9.55 for this service. The price depends on where it is billed: about $2.88 from a physician practice, and about $9.55 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 5 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$2.88$2.69 to $12.59
FacilityA hospital or hospital-owned outpatient department$9.55$9.55 to $11.75

How much rates vary

Facilitymedian $10 · 10th to 90th $3 to $28Professionalmedian $3 · 10th to 90th $3 to $126
$5$10$20$50$100$200facility $10professional $3

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
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.75
Typical High
$10.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.47
Median
$10.47
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$125.89
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$18.20
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$18.20
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$9.33
Typical High
$181.97
Providence
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$79.43
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana 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.

Montana· 10th of 51

$9.55

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.