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
HC Oasis Tri-Layer Wound Matrix 1 Inch X 1.4 Inch, per 1 Sq Cm (138895)
McCall, ID
See all hospitals reporting HCPCS Q4124 →Price type
St Luke's McCall, LTD’s median price of $30 is 72% below the median hospital's median price ($108), higher than 34% of the 1,428 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: 8 payers, 13 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 | Cigna hb mccall cigna fee schedule · outpatient | $3 | $3 | — | — | — | $3 – $3 |
| 2 | Molina hb mccall molina mmcp percent of total billed charges · bothfrom % of charges | $20 | $20 | — | — | — | $20 – $20 |
| 3 | Regence hb mccall medicare advantage percent of total billed charges · bothfrom % of charges | $20 | $20 | — | — | — | $20 – $20 |
| 4 | Blue Cross Blue Shield hb mccall bci true & secure med adv percent of total billed charges · bothfrom % of charges | $20 | $20 | — | — | — | $20 – $20 |
| 5 | Molina hb mccall molina med adv percent of total billed charges · bothfrom % of charges | $20 | $20 | — | — | — | $20 – $20 |
| 6 | Aetna hb mccall aetna med adv percent of total billed charges · bothfrom % of charges | $22 | $22 | — | — | — | $22 – $22 |
| 7 | Bcbs Id hb mccall bci percent of total billed charges · inpatientfrom % of charges | $30 | $30 | — | — | — | $30 – $30 |
| 8 | Blue Cross Blue Shield hb mccall bci percent of total billed charges · inpatientfrom % of charges | $30 | $30 | — | — | — | $30 – $30 |
| 9 | Aetna hb mccall aetna trinity health (st al's) percent of total billed charges · bothfrom % of charges | $31 | $31 | — | — | — | $31 – $31 |
| 10 | Cigna hb mccall cigna percent of total billed charges · inpatientfrom % of charges | $32 | $32 | — | — | — | $32 – $32 |
| 11 | Aetna hb mccall bp aetna percent of total billed charges · bothfrom % of charges | $32 | $32 | — | — | — | $32 – $32 |
| 12 | First Health hb mccall first choice health percent of total billed charges · bothfrom % of charges | $32 | $32 | — | — | — | $32 – $32 |
| 13 | UnitedHealthcare hb mccall united healthcare percent of total billed charges · bothfrom % of charges | $33 | $33 | — | — | — | $33 – $33 |
Last updated: Mar 25, 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.