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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 July 2026.

Facilitymedian $58 · 10th–90th $47$1820%20%10th90th$58Professionalmedian $51 · 10th–90th $48$1260%50%10th90th$51$20.0$50.0$100.0$200.0$500.0

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
$53.70
Median
$53.70
Typical High
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$51.29
Typical High
$54.95
BCBS
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$44.67
BCBS
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$58.88
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$53.70
Typical High
$112.20
Molina
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$51.29
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$125.89
Typical High
$125.89