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Integra Bilayer Matrix Wound Dressing

Washington, DC 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 $51 · 10th–90th $51$2630%50%90th$51Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. 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
$52.48
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$74.13
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$263.03
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$114.82
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$125.89
Typical High
$158.49