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Oasis Ultra Tri-Layer Wound Matrix

Nebraska 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?

$2.57

Typical negotiated rate. In Nebraska, July 2026.

Insurers have agreed to pay about $2.57 for this service. The price depends on where it is billed: about $2.51 from a physician practice, and about $4.27 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$2.51$2.51 to $2.95
FacilityA hospital or hospital-owned outpatient department$4.27$2.51 to $145

How much rates vary

Facilitymedian $4 · 10th to 90th $2 to $224Professionalmedian $3 · 10th to 90th $3 to $42
$10.0$100.0$1.0Kfacility $4professional $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
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.47
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.09
Median
$2.69
Typical High
$2.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$2.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$9.33
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$3.98
Typical High
$14.79
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$16.22
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.82
Median
$10.96
Typical High
$15.49
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$309.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$6.17
Median
$6.17
Typical High
$15.49
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$125.89
Typical High
$141.25

Where Nebraska sits

The same service costs 16.6 times more in Minnesota than in Illinois. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Nebraska $2.57 · 25th of 51
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.