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Amnio Wrap2

Ohio rates for HCPCS Q4221

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

Rates data updated July 2026.

Facilitymedian $417 · 10th–90th $102$2,2910%20%10th90th$417Professionalmedian $1,950 · 10th–90th $126$2,7540%20%40%10th90th$1,950$2.0$10.0$50.0$200.0$1.0K$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
$1,949.84
Median
$1,949.84
Typical High
$2,290.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,137.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$2,137.96
Typical High
$3,388.44
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,630.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$269.15
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$269.15
Typical High
$389.05
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$2,041.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$60.26
Typical High
$2,137.96
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$2,344.23
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90