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Oasis Ultra Tri-Layer Wound Matrix

New Jersey 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 $275 · 10th–90th $3$18,1970%10%10th90th$275Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$2.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.75
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.95
Median
$3.80
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$12.88
Typical High
$218.78
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$9,549.93
Typical High
$20,417.38
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$154.88
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$7.59
Median
$125.89
Typical High
$125.89