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Integra Bilayer Matrix Wound Dressing

Illinois 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 $191 · 10th–90th $51$2690%10%10th90th$191Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$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
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$56.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$204.17
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$194.98
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$58.88
Typical High
$120.23
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$125.89
Typical High
$125.89