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Integra Bilayer Matrix Wound Dressing

Wisconsin 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 $83 · 10th–90th $51$4900%20%10th90th$83Professionalmedian $68 · 10th–90th $51$1620%20%10th90th$68$5.0$20.0$100.0$500.0$2.0K

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
$52.48
Median
$52.48
Typical High
$52.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$61.66
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$67.61
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$162.18
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$125.89
Typical High
$151.36
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$112.20
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$56.23
Medica
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$54.95
Typical High
$117.49
Medica
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$120.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$52.48
Typical High
$54.95
Network Health
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$54.95
Typical High
$89.13
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$112.20
Quartz
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$229.09
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$660.69
Security Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$79.43
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54