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Alaska rates for HCPCS A2001

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,288.25 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,041.74 / $2,884.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $309.03 / $537.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,398.83 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,659.59 / $1,819.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $1,513.56 / $2,238.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $389.05 / $3,162.28