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Integra Bilayer Matrix Wound Dressing

Pennsylvania 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 Pennsylvania, 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 $178 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$69.18$51.29 to $126
FacilityA hospital or hospital-owned outpatient department$178$126 to $224

How much rates vary

Facilitymedian $178 · 10th to 90th $55 to $479Professionalmedian $69 · 10th to 90th $51 to $126
$50$100$200$500$1K$2K$5Kfacility $178professional $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
$51.29
Typical High
$51.29
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$61.66
Median
$69.18
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$69.18
Typical High
$69.18
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$69.18
Typical High
$234.42
Geisinger
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$120.23
Typical High
$199.53
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$27.54
Median
$27.54
Typical High
$77.62
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$47.86
Median
$181.97
Typical High
$309.03
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$47.86
Median
$54.95
Typical High
$54.95
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$134.90

Where Pennsylvania 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.

Pennsylvania· 35th 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.