go back

Integra Bilayer Matrix Wound Dressing

Oklahoma 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?

$126

Typical negotiated rate. In Oklahoma, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $54.95 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$126$53.70 to $126
FacilityA hospital or hospital-owned outpatient department$54.95$46.77 to $151

How much rates vary

Facilitymedian $55 · 10th to 90th $47 to $229Professionalmedian $126 · 10th to 90th $50 to $229
$50$100$200facility $55professional $126

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
$54.95
Median
$54.95
Typical High
$54.95
Aetna
Setting
Professional
Modifier
None
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
BCBS Oklahoma
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Cigna
Setting
Facility
Modifier
None
Typical Low
$141.25
Median
$169.82
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$46.77
Median
$46.77
Typical High
$74.13
Medica
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$53.70
Typical High
$229.09
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$125.89

Where Oklahoma 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.

Oklahoma· 5th of 51

$126

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.