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Integra Bilayer Matrix Wound Dressing

Massachusetts 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 $100 · 10th–90th $69$2340%20%10th90th$100Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$138.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$61.66
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$707.95
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$229.09
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$1,995.26
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$181.97
Typical High
$275.42
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$93.33
Health New England
Setting
Facility
Modifier
Global
Typical Low
$2,754.23
Median
$2,754.23
Typical High
$11,748.98
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$707.95
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$52.48
Typical High
$125.89