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Oasis Ultra Tri-Layer Wound Matrix

New Hampshire 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?

$2.51

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $2.51 for this service. The price depends on where it is billed: about $2.51 from a physician practice, and about $20.42 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 $12.88
FacilityA hospital or hospital-owned outpatient department$20.42$2.51 to $132

How much rates vary

Facilitymedian $20 · 10th to 90th $3 to $269Professionalmedian $3 · 10th to 90th $3 to $14
$5$10$20$50$100$200facility $20professional $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
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.02
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$14.45
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$4.68
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$11.48
Typical High
$125.89
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$79.43
Typical High
$87.10

Where New Hampshire 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.

New Hampshire· 39th of 51

$2.51

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.