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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 July 2026.

Facilitymedian $123 · 10th–90th $50$2570%10%20%10th90th$123Professionalmedian $102 · 10th–90th $43$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$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
$58.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$100.00
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$134.90
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$58.88
Typical High
$64.57
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$131.83
Typical High
$190.55
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$69.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$53.70
Typical High
$91.20
Medica
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$125.89
Typical High
$239.88