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HCPCS Q4102

Oasis wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)

Current codeSkin Substitute Products42 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Cascade Valley HospitalArlington$3.40 – $4808 plans$32.00$40.00
EvergreenHealth Medical CenterKirkland$5.76 – $3639 plans$14.40$18.00
Harborview Medical CenterSeattleFile dated 2026-04-01—$7,543$10,776
Highline Medical CenterBurienFile dated 2026-02-28$2.37 – $42.014 plans$1.69 – $14.26$5.51 – $46.67
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$291 – $568$415 – $812
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$408 – $700$583 – $1,000
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$432 – $860$831 – $1,655
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$408 – $700$583 – $1,000
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$386 – $664$552 – $949
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$478 – $947$920 – $1,820
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$386 – $664$552 – $949
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$336 – $618$480 – $883
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$432 – $860$831 – $1,655
Skagit Valley HospitalMount Vernon$5.77 – $38.007 plans$32.00$40.00
St Anthony HospitalGig HarborFile dated 2026-02-28$3.97 – $35.012 plans$1.68 – $14.20$5.51 – $46.67
St Clare HospitalLakewoodFile dated 2026-02-28$3.97 – $35.012 plans$1.59 – $13.46$5.51 – $46.67
St Elizabeth HospitalEnumclawFile dated 2026-02-28$2.21 – $42.015 plans$1.95 – $16.50$5.51 – $46.67
St Francis Community HospitalFederal WayFile dated 2026-02-28$3.97 – $35.012 plans$1.73 – $14.65$5.51 – $46.67
St Joseph Medical CenterTacomaFile dated 2026-02-28$3.97 – $35.012 plans$1.83 – $15.46$5.51 – $46.67
St Michael Medical CenterSilverdaleFile dated 2026-02-28$3.48 – $42.0110 plans$2.44 – $20.60$5.51 – $46.67
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$296 – $579$617 – $1,207
Swedish IssaquahIssaquahFile dated 2026-04-01—$296 – $579$617 – $1,207
Swedish Medical CenterSeattleFile dated 2026-04-01—$296 – $579$617 – $1,207
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$296 – $579$617 – $1,207
University of Washington Medical CtrSeattleFile dated 2026-04-01—$6,705$9,578
Virginia Mason Medical CenterSeattle$27.54 – $34.404 plans$21.93$43.00

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Doctor's fee, Seattle (King County)
$156 in an office; $156 in a hospital or surgery center
Doctor's fee, rest of Washington
$134 in an office; $134 in a hospital or surgery center
Hospital outpatient payment (national)
$127 (APC 6001)
Surgery center payment (national)
$127