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Oasis Ultra Tri-Layer Wound Matrix

Wisconsin 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 $10 · 10th–90th $3$4900%20%10th90th$10Professionalmedian $13 · 10th–90th $3$2000%20%10th90th$13$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$2.57
Median
$2.57
Typical High
$2.57
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.51
Median
$2.57
Typical High
$2.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$19.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$22.39
Median
$29.51
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$125.89
Typical High
$223.87
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.57
Typical High
$5.75
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$11.22
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.45
Median
$2.57
Typical High
$75.86
Medica
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$16.22
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$9.77
Median
$9.77
Typical High
$10.72
Network Health
Setting
Professional
Modifier
Global
Typical Low
$10.47
Median
$10.72
Typical High
$17.38
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$2.51
Median
$2.57
Typical High
$5.75
Quartz
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$229.09
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$5,370.32
Security Health
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$3.39
Typical High
$4.17
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54