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Oasis Ultra Tri-Layer Wound Matrix

Virginia 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$1910%20%40%10th90th$3Professionalmedian $4 · 10th–90th $3$1260%20%40%10th90th$4$2.0$10.0$50.0$200.0

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
$2.63
Typical High
$2.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$10.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$21.38
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$251.19
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$131.83
Typical High
$239.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.82
Typical High
$15.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.51
Typical High
$109.65
Sentara
Setting
Facility
Modifier
Global
Typical Low
$2.34
Median
$2.95
Typical High
$14.13
Sentara
Setting
Professional
Modifier
Global
Typical Low
$2.34
Median
$2.95
Typical High
$14.13
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$154.88
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89