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Amnio Wrap2

Tennessee rates for HCPCS Q4221

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

Rates data updated July 2026.

Facilitymedian $224 · 10th–90th $129$5,7540%20%10th90th$224Professionalmedian $1,950 · 10th–90th $126$2,1880%50%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
$1,949.84
Median
$1,949.84
Typical High
$3,467.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,041.74
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,344.23
Typical High
$2,344.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$5,754.40
Median
$5,754.40
Typical High
$5,754.40
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$6,456.54
Median
$8,317.64
Typical High
$8,317.64
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$125.89