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Integra Bilayer Matrix Wound Dressing

Tennessee 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 $170 · 10th–90th $34$7080%10%20%10th90th$170Professionalmedian $51 · 10th–90th $51$1260%50%90th$51$10.0$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
$33.88
Median
$51.29
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$53.70
BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$79.43
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$125.89
Typical High
$125.89