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Oasis Ultra Tri-Layer Wound Matrix

North Carolina 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 $10 · 10th–90th $3$1950%20%10th90th$10Professionalmedian $13 · 10th–90th $3$1150%20%10th90th$13$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$10.23
Median
$10.23
Typical High
$10.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$10.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$10.47
Median
$11.22
Typical High
$12.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$13.18
Typical High
$14.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$10.23
Typical High
$16.60
Medcost
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$208.93
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$5,370.32
Median
$5,370.32
Typical High
$5,370.32