Size Total
square cm
Quantity Order number
10mm Disk 0.8 1 each WC3010
14mm Disk 1.5 1 each WC3014
16mm Disk 2 1 each  WC3016
18mm Disk 2.5 1 each WC3018
2cm x 2cm 4 1 each WC3022
2cm x 3cm 6  1 each  WC3023
2cm x 4cm 8 1 each WC3024
3cm x 4cm 12 1 each WC3034
4cm x 4cm 16 1 each WC3044
3cm x 8cm 24  1 each  WC3038
4cm x 6cm 24 1 each WC3046
5cm x 6cm 30  1 each  WC3056
7cm x 7cm 49 1 each   WC3077
 HCPCS code    Description  
 Q4151    AmnioBand, per sq cm  
FOR MORE INFORMATION CONTACT
YOUR MTF REPRESENTATIVE:
MTFOP@mtf.org  |  1-800-433-6576
Order number Dry Coverage (cm*) Recommended Saline
for Rehydration (ml*)
Rehydrated Volume (cc*) Rehydrated Coverage (cm*) Size
WC3040 2 x 4 0.2 0.10 – 0.15  1 x 1 40 mg 
WC3080 4 x 4 0.4 0.25 – 0.30 1 x 1.5   80 mg
WC3160 4 x 8 0.8  0.30 – 0.35  1.5 x 2 160 mg 
 * Actual area of coverage and rehydrated volumes may vary based on clinical technique.
 HCPCS code    Description      
 Q4168    AmnioBand, 1 mg      
FOR MORE INFORMATION CONTACT
YOUR MTF REPRESENTATIVE:
MTFOP@mtf.org  |  1-800-433-6576
Order number Dimensions Thickness
WC1515  1.5cm x 1.5cm 0.4mm-1.0mm
WC0202  2cm x 2cm 0.4mm-1.0mm
WC0404  4cm x 4cm 0.4mm-1.0mm
WC0418  4cm x 8cm 0.4mm-1.0mm
HCPCS code Description  
Q4128  AlloPatch HD, per sq cm  
FOR MORE INFORMATION CONTACT
YOUR MTF REPRESENTATIVE:
MTFOP@mtf.org  |  1-800-433-6576