go back

Massachusetts rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $550 · 10th–90th $138–$4,3650%20%10th90th$550Professionalmedian $1,950 · 10th–90th $174–$2,1380%50%10th90th$1,950$100.0$500.0$2.0K$10.0K$50.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $2,290.87
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $5,754.40
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $269.15 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $181.97 / $3,388.44
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $275.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $5,754.40
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $4,897.79
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,311.31 / $4,365.16
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $1,949.84 / $2,041.74