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Oasis Ultra Tri-Layer Wound Matrix

Oregon 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?

$5.13

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $5.13 for this service. The price depends on where it is billed: about $126 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$126$2.51 to $219
FacilityA hospital or hospital-owned outpatient department$2.51$2.45 to $2.82

How much rates vary

Facilitymedian $3 · 10th to 90th $2 to $15Professionalmedian $126 · 10th to 90th $3 to $275
$10.0$100.0$1.0K$10.0K$100.0K$1.0Mfacility $3professional $126

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$41.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$18.20
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$257.04
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$3.72
Typical High
$141.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$239.88
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$2.51
Typical High
$3.72
Providence
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$12.88
Typical High
$245.47
Providence
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$79.43
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Oregon sits

The same service costs 16.6 times more in Minnesota than in Illinois. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Oregon $5.13 · 12th of 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.