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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 October 2026.

How much does Integra Bilayer Matrix Wound Dressing cost?

$56.23

Typical negotiated rate. In Montana, October 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 $126 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$56.23$48.98 to $79.43
FacilityA hospital or hospital-owned outpatient department$126$56.23 to $158

How much rates vary

Facilitymedian $126 · 10th to 90th $56 to $219Professionalmedian $56 · 10th to 90th $37 to $126
$20$50$100$200facility $126professional $56

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
Professional
Modifier
None
Typical Low
$51.29
Median
$52.48
Typical High
$61.66
Cigna
Setting
Facility
Modifier
None
Typical Low
$56.23
Median
$61.66
Typical High
$234.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$20.89
Median
$158.49
Typical High
$208.93
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$141.25
Typical High
$158.49
Providence
Setting
Facility
Modifier
None
Typical Low
$56.23
Median
$61.66
Typical High
$234.42
Providence
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$51.29
Typical High
$79.43
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana 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.

Montana· 46th of 51

$56.23

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.