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Integra Bilayer Matrix Wound Dressing

South Carolina 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?

$117

Typical negotiated rate. In South Carolina, October 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $117 from a physician practice, and about $166 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$117$53.70 to $126
FacilityA hospital or hospital-owned outpatient department$166$145 to $240

How much rates vary

Facilitymedian $166 · 10th to 90th $72 to $302Professionalmedian $117 · 10th to 90th $51 to $148
$20$50$100$200facility $166professional $117

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
$53.70
Median
$53.70
Typical High
$53.70
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$53.70
Typical High
$53.70
BCBS South Carolina
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$117.49
Typical High
$147.91
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$177.83
Typical High
$309.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
None
Typical Low
$30.90
Median
$58.88
Typical High
$144.54
Medcost
Setting
Professional
Modifier
None
Typical Low
$11.75
Median
$18.62
Typical High
$81.28
Molina
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$87.10
United
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
5 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$5.89
Median
$9.33
Typical High
$43.65
Medcost
Setting
Professional
Modifier
80 · Assistant surgeon
Typical Low
$2.34
Median
$3.72
Typical High
$17.78
Medcost
Setting
Professional
Modifier
81 · Minimal assistant surgeon
Typical Low
$1.66
Median
$2.63
Typical High
$12.30
Medcost
Setting
Professional
Modifier
82 · Assistant surgeon, no resident
Typical Low
$1.66
Median
$2.63
Typical High
$12.30
Medcost
Setting
Professional
Modifier
AS · PA/NP assist
Typical Low
$1.66
Median
$2.63
Typical High
$12.30

Where South Carolina 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.

South Carolina· 20th of 51

$117

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.