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Amnio Wrap2

Oregon 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?

$191

Typical negotiated rate. In Oregon, October 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $141 from a physician practice, and about $1,950 from a hospital or other facility.

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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$141$126 to $1,950
FacilityA hospital or hospital-owned outpatient department$1,950$1,862 to $2,455

How much rates vary

Facilitymedian $1,950 · 10th to 90th $1,862 to $3,548Professionalmedian $141 · 10th to 90th $126 to $1,950
$100$200$500$1K$2K$5Kfacility $1,950professional $141

Distribution of negotiated rates across all payers (price axis is log-scale). 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
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$269.15
Typical High
$4,073.80
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$275.42
Typical High
$346.74
Moda Health
Setting
Facility
Modifier
None
Typical Low
$1,949.84
Median
$2,630.27
Typical High
$2,818.38
Moda Health
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$416.87
Typical High
$1,949.84
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$1,862.09
Median
$1,949.84
Typical High
$3,548.13
Providence
Setting
Facility
Modifier
None
Typical Low
$117.49
Median
$269.15
Typical High
$4,073.80
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$125.89
Typical High
$2,511.89
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$204.17
Typical High
$218.78
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
8 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
Moda Health
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Moda Health
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
Moda Health
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Moda Health
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$194.98
Median
$194.98
Typical High
$194.98

Where Oregon 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.

Oregon· 30th of 51

$191

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.