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Integra Bilayer Matrix Wound Dressing

Maine 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 $145 · 10th–90th $145$3630%50%90th$145Professionalmedian $51 · 10th–90th $51$1070%50%90th$51$20.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$52.48
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$69.18
Typical High
$69.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$61.66
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$51.29
Typical High
$125.89