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Amnio Wrap2

Michigan rates for HCPCS Q4221

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

Rates data updated July 2026.

Facilitymedian $2,042 · 10th–90th $102$2,6920%20%40%10th90th$2,042Professionalmedian $1,950 · 10th–90th $120$2,0420%20%10th90th$1,950$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,041.74
BCBS
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$120.23
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$2,187.76
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$2,691.53
Typical High
$7,413.10
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$2,041.74
Typical High
$3,311.31
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$2,089.30
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$2,398.83
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90