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Integra Bilayer Matrix Wound Dressing

Minnesota 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?

$64.57

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $64.57 for this service. The price depends on where it is billed: about $64.57 from a physician practice, and about $95.50 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$64.57$51.29 to $186
FacilityA hospital or hospital-owned outpatient department$95.50$52.48 to $135

How much rates vary

Facilitymedian $95 · 10th to 90th $52 to $251Professionalmedian $65 · 10th to 90th $51 to $229
$50$100$200facility $95professional $65

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
$52.48
Median
$52.48
Typical High
$52.48
Aetna
Setting
Professional
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$104.71
Typical High
$257.04
BCBS Minnesota
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$194.98
Typical High
$239.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$120.23
Typical High
$190.55
Cigna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$56.23
Typical High
$64.57
Health Partners
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$109.65
Typical High
$186.21
Health Partners
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Medica
Setting
Facility
Modifier
None
Typical Low
$26.92
Median
$53.70
Typical High
$91.20
Medica
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$53.70
Typical High
$229.09
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$186.21
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
BCBS Minnesota
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$28.84
Median
$45.71
Typical High
$125.89

Where Minnesota 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.

Minnesota· 39th of 51

$64.57

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.