go back

Oasis Ultra Tri-Layer Wound Matrix

New York 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$1740%50%90th$3Professionalmedian $9 · 10th–90th $3$1260%20%10th90th$9$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
$2.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.49
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$138.04
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$12.88
Typical High
$229.09
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.57
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.57
Typical High
$2.57
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$3.16
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$9.55
Typical High
$11.75
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$6.61
Median
$9.33
Typical High
$125.89
Univera
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.02
Univera
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.57
Typical High
$2.57