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Oasis Ultra Tri-Layer Wound Matrix

Pennsylvania 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?

$2.51

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $2.51 for this service. The price depends on where it is billed: about $2.51 from a physician practice, and about $4.27 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$2.51$2.51 to $2.95
FacilityA hospital or hospital-owned outpatient department$4.27$2.51 to $15.49

How much rates vary

Facilitymedian $4 · 10th to 90th $3 to $447Professionalmedian $3 · 10th to 90th $3 to $126
$10.0$100.0$1.0K$10.0Kfacility $4professional $3

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
$4.27
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.75
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$12.59
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$223.87
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$218.78
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$4.27
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.63
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$10.47
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$10.47
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$125.89
Typical High
$134.90

Where Pennsylvania 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.

Pennsylvania $2.51 · 48th 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.