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.
Original text from hospital filings
OASIS ULTRA TRI-LAYER WOUND MATRIX, PER SQUARE CENTIMETER
Custer, SD
See all hospitals reporting HCPCS Q4124 →Price type
Monument Health Network Inc’s median price of $284 is 164% above the median hospital's median price ($108), higher than 83% of the 1,422 hospitals reporting HCPCS Q4124. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 10 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare uhc mcr adv percent of total billed charges · outpatientfrom % of charges | $75 | $593 | $713 | 120% | — | $16 – $2.2k |
| 2 | Medica medica mcr adv percent of total billed charges · outpatientfrom % of charges | $77 | $608 | $731 | 120% | — | $16 – $2.2k |
| 3 | Wellmark bcbs wellmark mcr adv percent of total billed charges · outpatientfrom % of charges | $77 | $608 | $731 | 120% | — | $16 – $2.2k |
| 4 | Medica medica mcaid percent of total billed charges · outpatientfrom % of charges | $100 | $790 | $950 | 120% | — | $21 – $2.9k |
| 5 | Wellmark bcbs wellmark - all other plans percent of total billed charges · outpatientfrom % of charges | $271 | $2.1k | $2.6k | 120% | — | $57 – $7.9k |
| 6 | Aetna aetna - all plans percent of total billed charges · outpatientfrom % of charges | $286 | $2.3k | $2.7k | 120% | — | $60 – $8.3k |
| 7 | MultiPlan multiplan/phcs - all plans percent of total billed charges · outpatientfrom % of charges | $286 | $2.3k | $2.7k | 120% | — | $60 – $8.3k |
| 8 | Medica medica commercial - all other plans percent of total billed charges · outpatientfrom % of charges | $292 | $2.3k | $2.8k | 120% | — | $61 – $8.5k |
| 9 | UnitedHealthcare uhc - all other plans percent of total billed charges · outpatientfrom % of charges | $292 | $2.3k | $2.8k | 120% | — | $61 – $8.5k |
| 10 | Humana humana commercial - all plans percent of total billed charges · outpatientfrom % of charges | $301 | $2.4k | $2.9k | 120% | — | $63 – $8.7k |
Last updated: Sep 1, 2026
See Oasis ultra tri-layer wound matrix, per square centimeter pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.