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Integra Bilayer Matrix Wound Dressing

Oregon 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 $49$1050%20%40%10th90th$51Professionalmedian $126 · 10th–90th $51$2750%20%10th90th$126$10.0$100.0$1.0K$10.0K$100.0K$1.0M

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$100.00
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$257.04
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$54.95
Typical High
$141.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$239.88
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$51.29
Typical High
$52.48
Providence
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$70.79
Typical High
$245.47
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89