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Integra Bilayer Matrix Wound Dressing

South Dakota 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?

$57.54

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $57.54 for this service. The price depends on where it is billed: about $58.88 from a physician practice, and about $51.29 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$58.88$51.29 to $69.18
FacilityA hospital or hospital-owned outpatient department$51.29$51.29 to $81.28

How much rates vary

Facilitymedian $51 · 10th to 90th $51 to $91Professionalmedian $59 · 10th to 90th $51 to $126
$50$100$200facility $51professional $59

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
$81.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$53.70
Cigna
Setting
Facility
Modifier
None
Typical Low
$30.90
Median
$67.61
Typical High
$169.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$63.10
Typical High
$64.57
Medica
Setting
Facility
Modifier
None
Typical Low
$77.62
Median
$91.20
Typical High
$91.20
Medica
Setting
Professional
Modifier
None
Typical Low
$45.71
Median
$53.70
Typical High
$123.03
Midlands
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Midlands
Setting
Facility
Modifier
None
Typical Low
$30.90
Median
$30.90
Typical High
$204.17
Midlands
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$100.00
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$69.18
Typical High
$69.18
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$141.25
Wellmark
Setting
Facility
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Wellmark
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29

Where South Dakota 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 Dakota· 44th of 51

$57.54

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.