What does code Q4104 cost?

Across the published hospital price files, the disclosed cash price for Q4104 ranges from $57.50 to $8,845. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Will this be my final bill?

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

Q4104 is the billing code hospitals use to identify "Integra bmwd" on their published price files. We use it to line up the same service across different hospitals.

Why do prices for this code differ between hospitals?

Each hospital sets its own prices and negotiates separately with each insurer, so the disclosed price for the same code can vary widely from one hospital to another — and even between plans at a single hospital. Comparing the published figures is what this page is for; a difference does not by itself mean one hospital is better or worse.

What this page is not

It is not a quote, a guarantee, or medical advice. It shows what hospitals have published for this code, so you can compare and ask informed questions — your actual cost depends on your insurance, the exact services performed, and the care setting.

Q4104

HCPCS

Integra bmwd

Verified from hospital fileNot a bill estimate

iDirect answer

Based on the latest published hospital price files, code Q4104 (Integra bmwd) appears at 26 hospitals with disclosed cash prices from $57.50 to $8,845. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Published-price availability

hospitals publish a price

list this service without a published price

Cash

List

Negotiated

Allowed

A blank price (“—”) means a hospital names this service but did not publish a dollar amount — it is not a free service or a $0 price.

Compare Q4104 prices

Filter by hospital, city, setting, or payer — the summary and charts update with your filters.

Based on hospital-published prices verified from each hospital’s own file. Coverage expands as data is verified.

Published cash prices for code Q4104 vary by about 154× across the 24 hospitals with disclosed prices here — from $57.50 to $8,845. Shopping around can matter.

Hospitals

Prices shown

$57.50

Lowest cash

$8,845

Highest cash

code Q4104 cash price53 disclosed · 24 hospitals

$57.50median ~$372$8,845

Lowest cash price by hospital

Cash price by city

Reflects your current filters.

Cash price by city$57.50 – $571

Burlington · 1 hospital$57.50
Grafton · 1 hospital$57.50–$571
Chicago · 1 hospital$78.00
Arlington · 2 hospitals$103–$410
Flower Mound · 1 hospital$103–$410
Frisco · 1 hospital$103–$410

56 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
Integra bmwd Outpatient	Endeavor Health Edward Hospital	Q4104 HCPCS	—	—	$119 – $215	—
Noncdm Charge Record Medical Supplies Inpatient & outpatient	University of Chicago Medical Center	Q4104 HCPCS	—	—	—	—
Integra bmwd Outpatient	University of Chicago Medical Center	Q4104 HCPCS	—	—	—	—
HB SKIN SUBS, INTEGRA BMWD, PER SQ CM Inpatient & outpatient	Endeavor Health Swedish Hospital	Q4104 HCPCS	$78.00	$78.00	—	—
HC OR 636 Q4104 INTEGRA BMWD PER SQ CM Inpatient	Deaconess Gateway Hospital	Q4104 HCPCS	$4,046	$1,335	$1,335 – $3,560	—
INTEGRA BMWD PER SQ CM Inpatient	Aurora Medical Center Burlington	Q4104 HCPCS	$115	$57.50	$69.00 – $97.75	—
1204568 - MATRIX WND 5 CM X 5 CM 25 CM2 MESH BILAYER CLGN Inpatient	Aurora Medical Center Grafton	Q4104 HCPCS	$1,142	$571	$685 – $971	—
INTEGRA BMWD PER SQ CM Inpatient	Aurora Medical Center Grafton	Q4104 HCPCS	$115	$57.50	$69.00 – $97.75	—
DRESSING WOUND BILAYER 2X2IN58990 Outpatient	Paul Oliver Memorial Hospital	Q4104 HCPCS	$5,968	$5,072	$87.82 – $5,669	—
DRESSING WOUND BILAYER 4X5IN29846 Outpatient	Paul Oliver Memorial Hospital	Q4104 HCPCS	$10,406	$8,845	$87.82 – $9,885	—
MATRIX BLYR WND 10X12.5/125SQCM Outpatient	Texas Health Presbyterian Hospital Allen	Q4104 HCPCS	$238	$143	$27.44 – $375	—
MATRIX BLYR WND 5X5/25 SQCM Outpatient	Texas Health Presbyterian Hospital Allen	Q4104 HCPCS	$683	$410	$52.49 – $643	—
MATRIX BLYR WND 10X12.5/125SQCM Outpatient	Texas Health Harris Methodist Hospital Alliance	Q4104 HCPCS	$238	$143	$24.46 – $375	—
MATRIX BLYR WND 5X5/25 SQCM Outpatient	Texas Health Harris Methodist Hospital Alliance	Q4104 HCPCS	$683	$410	$52.49 – $643	—
MATRIX BLYR WND 10X12.5/125SQCM Inpatient	Texas Health Arlington Memorial Hospital	Q4104 HCPCS	$238	$143	$82.37 – $224	—
MATRIX BLYR WND 5X5/25 SQCM Inpatient	Texas Health Arlington Memorial Hospital	Q4104 HCPCS	$683	$410	$236 – $643	—
GRAFTJACKET NOW THK 4X8/32SQCM Inpatient	Texas Health Arlington Memorial Hospital	Q4104 HCPCS	$621	$372	$215 – $584	—
MATRIX BLYR WND 10X25/250 SQCM Inpatient	Texas Health Arlington Memorial Hospital	Q4104 HCPCS	$172	$103	$59.59 – $162	—
MATRIX BLYR WND 10X12.5/125SQCM Outpatient	Texas Health Harris Methodist Hospital Azle	Q4104 HCPCS	$238	$143	$26.08 – $375	—
MATRIX BLYR WND 5X5/25 SQCM Outpatient	Texas Health Harris Methodist Hospital Azle	Q4104 HCPCS	$683	$410	$74.80 – $643	—
MATRIX BLYR WND 10X12.5/125SQCM Inpatient	Texas Health Harris Methodist Hospital Cleburne	Q4104 HCPCS	$238	$143	$82.37 – $229	—
MATRIX BLYR WND 5X5/25 SQCM Inpatient	Texas Health Harris Methodist Hospital Cleburne	Q4104 HCPCS	$683	$410	$236 – $656	—
MATRIX BLYR WND 10X12.5/125SQCM Outpatient	Texas Health Presbyterian Hospital Dallas	Q4104 HCPCS	$238	$143	$22.30 – $375	—
MATRIX BLYR WND 5X5/25 SQCM Outpatient	Texas Health Presbyterian Hospital Dallas	Q4104 HCPCS	$683	$410	$52.49 – $643	—
MATRIX BLYR WND 10X12.5/125SQCM Inpatient	Texas Health Presbyterian Hospital Denton	Q4104 HCPCS	$238	$143	$82.37 – $224	—

How to read these prices

Cash price: The discounted self-pay price for paying directly, without insurance.
List price: The hospital’s full undiscounted charge — rarely what anyone pays.
Negotiated rate: A rate for a specific insurer and plan; your share depends on your benefits.
Allowed amount: A historical reference for what was actually allowed, where disclosed.

Hospitals that publish Q4104 prices

Open a hospital to see this code in the context of its full published prices.

Code Q4104: frequently asked

What does code Q4104 cost?: Across the published hospital price files, the disclosed cash price for Q4104 ranges from $57.50 to $8,845. This is public hospital price transparency data, not a guaranteed estimate of your bill.
Will this be my final bill?: Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.
What is code Q4104?: Q4104 is the billing code hospitals use to identify "Integra bmwd" on their published price files. We use it to line up the same service across different hospitals.
Why do prices for this code differ between hospitals?: Each hospital sets its own prices and negotiates separately with each insurer, so the disclosed price for the same code can vary widely from one hospital to another — and even between plans at a single hospital. Comparing the published figures is what this page is for; a difference does not by itself mean one hospital is better or worse.
What this page is not: It is not a quote, a guarantee, or medical advice. It shows what hospitals have published for this code, so you can compare and ask informed questions — your actual cost depends on your insurance, the exact services performed, and the care setting.

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Hospitals publishing code Q4104 by state

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