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Integra Bilayer Matrix Wound Dressing

New Mexico 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 $141 · 10th–90th $51$3630%10%10th90th$141Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$10.0$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$64.57
BCBS
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$234.42
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$57.54
Typical High
$112.20
Providence
Setting
Facility
Modifier
Global
Typical Low
$19.05
Median
$56.23
Typical High
$181.97
Providence
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89