go back

Integra Bilayer Matrix Wound Dressing

Missouri 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 $83 · 10th–90th $51$2090%20%10th90th$83Professionalmedian $66 · 10th–90th $51$1410%20%10th90th$66$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
$52.48
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$97.72
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$69.18
Typical High
$154.88
Medica
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$53.70
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$125.89
Typical High
$125.89