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Amnio Wrap2

New Hampshire rates for HCPCS Q4221

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

Rates data updated October 2026.

How much does Amnio Wrap2 cost?

$126

Typical negotiated rate. In New Hampshire, October 2026.

Insurers have agreed to pay about $126 for this service. Most negotiated rates run $126 to $1,950.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $251 · 10th to 90th $200 to $339Professionalmedian $126 · 10th to 90th $126 to $1,950
$100$200$500$1K$2Kfacility $251professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Cigna
Setting
Facility
Modifier
None
Typical Low
$199.53
Median
$251.19
Typical High
$338.84
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$1,949.84
Typical High
$2,754.23
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$194.98
Median
$194.98
Typical High
$194.98

Where New Hampshire sits

The same service costs 19.5 times more in Alaska than in North Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New Hampshire· 43rd of 51

$126

AK $2,291NC $117

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.