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Oasis Ultra Tri-Layer Wound Matrix

South Dakota 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?

$3.09

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $3.09 for this service. The price depends on where it is billed: about $3.09 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 7 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$3.09$2.51 to $12.88
FacilityA hospital or hospital-owned outpatient department$2.51$2.51 to $12.30

How much rates vary

Facilitymedian $3 · 10th to 90th $3 to $18Professionalmedian $3 · 10th to 90th $3 to $15
$10.0$100.0$1.0Kfacility $3professional $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
$15.14
Typical High
$15.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$3.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$15.49
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$9.33
Typical High
$11.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$4.17
Typical High
$15.14
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$5,370.32
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2.95
Median
$2.95
Typical High
$10.96
Midlands
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
United
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$2.51

Where South Dakota 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.

South Dakota $3.09 · 15th 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.