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Integra Bilayer Matrix Wound Dressing

Kentucky 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$1740%50%90th$51Professionalmedian $51 · 10th–90th $51$780%50%90th$51$10.0$20.0$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. 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
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$61.66
CareSource
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$81.28
CareSource
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$54.95
Typical High
$70.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$125.89
Typical High
$616.60
Molina
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$70.79
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$125.89
Typical High
$125.89