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Integra Bilayer Matrix Wound Dressing

Connecticut 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 $145 · 10th–90th $52$2450%20%10th90th$145Professionalmedian $51 · 10th–90th $51$1100%50%90th$51$50.0$100.0$200.0

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
$52.48
Median
$52.48
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$56.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$69.18
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$69.18
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
United
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$125.89