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Amnio Wrap2

Wisconsin 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 $389$5,7540%20%10th90th$2,042Professionalmedian $2,042 · 10th–90th $126$4,2660%20%10th90th$2,042$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$2,041.74
Typical High
$2,137.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$2,818.38
Typical High
$5,888.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$5,623.41
Typical High
$8,317.64
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$223.87
Typical High
$2,570.40
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$2,041.74
Typical High
$4,365.16
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$2,041.74
Typical High
$4,365.16
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$4,073.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$1,778.28
Typical High
$1,778.28
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$2,041.74
Typical High
$4,365.16
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$3,548.13
Quartz
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$5,754.40
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$144.54
Typical High
$7,585.78
Security Health
Setting
Professional
Modifier
Global
Typical Low
$2,630.27
Median
$2,630.27
Typical High
$3,235.94
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$169.82