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Integra Bilayer Matrix Wound Dressing

Hawaii 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.

Professionalmedian $51 · 10th–90th $51$1450%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
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$56.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$66.07
Typical High
$125.89
HMSA
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$79.43
Typical High
$95.50
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$125.89
Typical High
$125.89