Oasis ultra tri-layer wound matrix, per square centimeter

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

MATRIX, WOUND OASIS 3X3.5

Payers reporting HCPCS Q4124

Payer pricing summary

Low

Average

$395

Median

$205

High

$3.4k

Payer rate distribution

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#
1	Blue Cross Blue Shield fee schedule · outpatient · +24 other terms	214	$121	$314	$797	254%	1–10	$1 – $7.8k
2	UnitedHealthcare fee schedule · outpatient · +22 other terms	513	$130	$179	$449	251%	—	$1 – $6.9k
3	Cigna fee schedule · outpatient · +22 other terms	361	$18	$372	$1.7k	470%	—	$2 – $25.4k
4	Aetna fee schedule · outpatient · +23 other terms	296	$127	$287	$736	256%	—	$1 – $6.8k
5	Humana fee schedule · outpatient · +20 other terms	216	$116	$214	$733	342%	—	$1 – $8.3k
6	Molina fee schedule · outpatient · +18 other terms	103	$148	$103	$109	106%	—	$1 – $682
7	Anthem fee schedule · outpatient · +19 other terms	72	$125	$160	$1.1k	659%	—	$2 – $22.6k
8	Caresource fee schedule · outpatient · +12 other terms	69	$17	$203	$219	108%	—	$1 – $524
9	MultiPlan fee schedule · inpatient · +16 other terms	65	$1.5k	$2.4k	$3.6k	150%	—	$11 – $27.4k
10	Kaiser fee schedule · outpatient · +15 other terms	64	$286	$594	$1.2k	200%	—	$3 – $9.5k
11	WellCare fee schedule · outpatient · +18 other terms	59	$135	$125	$54	43%	—	$2 – $228
12	Ambetter fee schedule · outpatient · +13 other terms	48	$234	$274	$116	42%	—	$2 – $406
13	Devoted fee schedule · outpatient · +10 other terms	34	$126	$126	$8	6%	—	$116 – $139
14	Optum fee schedule · outpatient · +13 other terms	34	$125	$181	$104	57%	—	$3 – $459
15	Highmark facility · fee schedule · outpatient · +12 other terms	32	$74	$94	$84	89%	—	$2 – $401
16	Oscar facility · fee schedule · outpatient · +12 other terms	30	$89	$121	$88	73%	—	$3 – $234
17	Medica fee schedule · outpatient · +14 other terms	27	$357	$805	$1.2k	150%	—	$11 – $3.5k
18	Bcbs La fee schedule · outpatient · +2 other terms	25	$10	$11	$1	11%	—	$10 – $14
19	First Health fee schedule · outpatient · +13 other terms	23	$1.4k	$2.7k	$4.2k	157%	—	$17 – $24.0k
20	Medicare fee schedule · outpatient · +9 other terms	23	$125	$128	$7	5%	—	$121 – $139
21	Regence professional · fee schedule · outpatient · +10 other terms	21	$9	$16	$30	191%	—	$9 – $153
22	Tricare facility · fee schedule · outpatient · +10 other terms	20	$127	$269	$598	222%	—	$19 – $3.1k
23	Aetna Better Health other · outpatient · +10 other terms	19	$216	$283	$264	93%	—	$5 – $1.4k
24	Amerihealth Caritas other · outpatient · +8 other terms	19	$216	$283	$264	93%	—	$5 – $1.4k
25	Healthpartners fee schedule · outpatient · +5 other terms	19	$12	$15	$19	125%	—	$12 – $131

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