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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.

Facilitymedian $4 · 10th–90th $2$2240%10%20%10th90th$4Professionalmedian $3 · 10th–90th $3$420%50%90th$3$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
$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