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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.

How much does Oasis Ultra Tri-Layer Wound Matrix cost?

$9.12

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $9.12 for this service. The price depends on where it is billed: about $9.12 from a physician practice, and about $2.51 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 8 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$9.12$2.51 to $12.59
FacilityA hospital or hospital-owned outpatient department$2.51$2.51 to $126

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $174Professionalmedian $9 · 10th to 90th $3 to $126
$10$100$1K$10Kfacility $3professional $9

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
$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

Where New York 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 York· 11th of 51

$9.12

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.