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Amnio Wrap2

Washington rates for HCPCS Q4221

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

Rates data updated July 2026.

Facilitymedian $1,950 · 10th–90th $347$4,1690%20%10th90th$1,950Professionalmedian $1,950 · 10th–90th $126$2,4550%20%10th90th$1,950$50.0$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
$2,137.96
Median
$2,137.96
Typical High
$2,137.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$2,454.71
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$562.34
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$3,162.28
Typical High
$4,897.79
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,801.89
Typical High
$5,128.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$50.12
Typical High
$60.26
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$1,949.84
Typical High
$2,238.72
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$2,089.30
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$2,238.72
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$295.12