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Integra Bilayer Matrix Wound Dressing

Arizona rates for HCPCS Q4104

Integra bilayer matrix wound dressing (BMWD), per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated October 2026.

How much does Integra Bilayer Matrix Wound Dressing cost?

$115

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $107 from a physician practice, and about $135 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$107$56.23 to $126
FacilityA hospital or hospital-owned outpatient department$135$63.10 to $200

How much rates vary

Facilitymedian $135 · 10th to 90th $40 to $263Professionalmedian $107 · 10th to 90th $54 to $229
$50$100$200facility $135professional $107

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$53.70
Median
$56.23
Typical High
$56.23
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$39.81
Median
$95.50
Typical High
$251.19
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$100.00
Typical High
$223.87
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$263.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$15.85
Median
$64.57
Typical High
$85.11
Medica
Setting
Professional
Modifier
None
Typical Low
$53.70
Median
$53.70
Typical High
$229.09
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Arizona sits

The same service costs 2.5 times more in Florida than in Indiana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Arizona· 22nd of 51

$115

FL $126IN $51.29

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.