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Integra Bilayer Matrix Wound Dressing

Indiana 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 October 2026.

How much does Integra Bilayer Matrix Wound Dressing cost?

$51.29

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $51.29 for this service. The price depends on where it is billed: about $51.29 from a physician practice, and about $186 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$51.29$51.29 to $126
FacilityA hospital or hospital-owned outpatient department$186$141 to $275

How much rates vary

Facilitymedian $186 · 10th to 90th $110 to $417Professionalmedian $51 · 10th to 90th $51 to $126
$50$100$200$500$1K$2Kfacility $186professional $51

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$147.91
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$117.49
CareSource
Setting
Facility
Modifier
None
Typical Low
$51.29
Median
$75.86
Typical High
$102.33
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$229.09
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$616.60
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$158.49
Typical High
$2,137.96
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$64.57
Typical High
$190.55
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$173.78

Where Indiana sits

The same service costs 2.5 times more in Florida than in Indiana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Indiana· 51st of 51

$51.29

FL $126IN $51.29

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.