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Integra Bilayer Matrix Wound Dressing

New York 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?

$69.18

Typical negotiated rate. In New York, October 2026.

Insurers have agreed to pay about $69.18 for this service. The price depends on where it is billed: about $69.18 from a physician practice, and about $70.79 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 10 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$69.18$67.61 to $126
FacilityA hospital or hospital-owned outpatient department$70.79$70.79 to $182

How much rates vary

Facilitymedian $71 · 10th to 90th $69 to $288Professionalmedian $69 · 10th to 90th $51 to $135
$20$50$100$200$500facility $71professional $69

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
Facility
Modifier
None
Typical Low
$51.29
Median
$54.95
Typical High
$186.21
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
CDPHP
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$186.21
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$144.54
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$69.18
Typical High
$151.36
Excellus BCBS
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$70.79
Typical High
$70.79
Excellus BCBS
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$70.79
Typical High
$70.79
Highmark BCBS
Setting
Facility
Modifier
None
Typical Low
$6,606.93
Median
$6,606.93
Typical High
$6,606.93
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$69.18
Typical High
$147.91
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$52.48
Median
$63.10
Typical High
$63.10
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$165.96
Univera
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$70.79
Typical High
$70.79
Univera
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$70.79
Typical High
$70.79

Where New York 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.

New York· 29th of 51

$69.18

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.