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Washington rates for HCPCS A2001

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $1,737.80 / $2,884.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,290.87 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $2,137.96
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,288.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $151.36 / $1,258.93
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $154.88 / $257.04