HCPCS Q4104
Integra bilayer matrix wound dressing (bmwd), per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products40 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | $5,470 – $19,913 | $13,675 – $49,783 |
| Cascade Valley Hospital | $5,344 – $15,609 | $4,238 – $11,849 | $5,298 – $14,811 |
| Deaconess Medical Center | — | $5,470 – $19,913 | $13,675 – $49,783 |
| Harborview Medical Center | — | $6,834 – $30,408 | $9,762 – $43,440 |
| Highline Medical Center | — | $4,821 – $10,240 | $15,788 – $33,535 |
| Island Hospital | $149 | — | — |
| Kadlec Regional Medical Center | — | $5,269 – $21,906 | $7,527 – $31,294 |
| Legacy Salmon Creek Medical Center | — | — | — |
| Mary Bridge Children's Hospital | — | $5,470 – $19,913 | $13,675 – $49,783 |
| MultiCare Auburn Medical Center | — | $5,470 – $19,913 | $13,675 – $49,783 |
| MultiCare Covington Medical Center | — | $5,470 – $19,913 | $13,675 – $49,783 |
| MultiCare Good Samaritan Hospital | — | $5,470 – $19,913 | $13,675 – $49,783 |
| MultiCare Valley Hospital | — | $5,470 – $19,913 | $13,675 – $49,783 |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $7,238 – $27,640 | $10,340 – $39,486 |
| Providence Centralia Hospital | — | $11,724 – $24,916 | $22,547 – $47,914 |
| Providence Holy Family Hospital | — | $7,238 – $27,640 | $10,340 – $39,486 |
| Providence Mount Carmel Hospital | — | $6,917 – $26,518 | $9,881 – $37,882 |
| Providence Regional Medical Center Everett | — | $9,948 – $36,595 | $19,132 – $70,374 |
| Providence St Joseph Hospital | — | $6,917 – $26,518 | $9,881 – $37,882 |
| Providence St Mary Medical Center | — | $6,104 – $25,260 | $8,720 – $36,086 |
| Providence St Peter Hospital | — | $11,724 – $24,916 | $22,547 – $47,914 |
| Seattle Children's Hospital | — | $20,343 | $20,343 |
| Skagit Valley Hospital | — | $4,238 – $11,849 | $5,298 – $14,811 |
| St Anthony Hospital | — | $4,802 – $10,199 | $15,788 – $33,535 |
| St Clare Hospital | — | $4,551 – $9,666 | $15,788 – $33,535 |
| St Elizabeth Hospital | $2,684 – $6,942 | $5,579 – $11,850 | $15,788 – $33,535 |
| St Francis Community Hospital | — | $4,955 – $10,524 | $15,788 – $33,535 |
| St Joseph Medical Center | — | $5,229 – $11,107 | $15,788 – $33,535 |
| St Michael Medical Center | — | $6,968 – $14,800 | $15,788 – $33,535 |
| Swedish Edmonds Hospital | — | $6,844 – $28,749 | $14,258 – $59,893 |
| Swedish Issaquah | — | $6,844 – $28,749 | $14,258 – $59,893 |
| Swedish Medical Center | — | $6,844 – $28,749 | $14,258 – $59,893 |
| Swedish Medical Center / Cherry Hill | — | $6,844 – $28,749 | $14,258 – $59,893 |
| Tacoma General Allenmore Hospital | — | $5,470 – $19,913 | $13,675 – $49,783 |
| University of Washington Medical Ctr | — | $477 – $27,247 | $681 – $38,924 |
| Virginia Mason Medical Center | — | $55.59 – $1,786 | $109 – $3,501 |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | — | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $156 in an office; $156 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $134 in an office; $134 in a hospital or surgery center
- Hospital outpatient payment (national)
- $127 (APC 6001)
- Surgery center payment (national)
- $127