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Integra Bilayer Matrix Wound Dressing

Colorado 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 July 2026.

Facilitymedian $52 · 10th–90th $50$1820%20%40%10th90th$52Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$56.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$67.61
Cigna
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$144.54
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$51.29
Typical High
$102.33
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$190.55
Typical High
$213.80
Select Health
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$208.93
Typical High
$281.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$208.93
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89