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Oasis Ultra Tri-Layer Wound Matrix

Nevada 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 $3 · 10th–90th $3$1450%50%90th$3Professionalmedian $3 · 10th–90th $3$1260%50%90th$3$1.0$5.0$20.0$100.0

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
$2.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$12.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$128.82
Select Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$128.82
Typical High
$128.82
Select Health
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$131.83
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$125.89
Typical High
$147.91