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Integra Bilayer Matrix Wound Dressing

Montana 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.

How much does Integra Bilayer Matrix Wound Dressing cost?

$56.23

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $56.23 for this service. The price depends on where it is billed: about $56.23 from a physician practice, and about $56.23 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$56.23$51.29 to $66.07
FacilityA hospital or hospital-owned outpatient department$56.23$51.29 to $67.61

How much rates vary

Facilitymedian $56 · 10th to 90th $49 to $151Professionalmedian $56 · 10th to 90th $51 to $126
$10.0$100.0$1.0K$10.0K$100.0Kfacility $56professional $56

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$56.23
Typical High
$63.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$125.89
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$51.29
Typical High
$95.50
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$51.29
Typical High
$95.50
Providence
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$56.23
Typical High
$181.97
Providence
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$74.13
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana sits

The same service costs 2.0 times more in Minnesota than in Tennessee. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Montana $56.23 · 13th of 51
MN $102TN $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.