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Integra Bilayer Matrix Wound Dressing

Mississippi 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 $52 · 10th–90th $17$1350%20%10th90th$52Professionalmedian $52 · 10th–90th $51$1260%50%10th90th$52$2.0$5.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$61.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$61.66
BCBS
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$18.62
BCBS
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$16.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$128.82