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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 July 2026.

Facilitymedian $51 · 10th–90th $51$1820%50%90th$51Professionalmedian $52 · 10th–90th $49$1200%50%10th90th$52$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$53.70
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$63.10
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$151.36
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$162.18
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$52.48
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$52.48
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$58.88
Typical High
$63.10
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$51.29
Typical High
$125.89
Univera
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$56.23
Univera
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$52.48