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Alaska rates for HCPCS A2015

Phoenix Wound Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.69 / $142.69 / $142.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.24 / $785.24 / $785.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.69 / $142.69 / $199.77
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,798.33 / $1,798.33 / $1,798.33
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,495.87 / $3,495.87 / $3,495.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.69 / $142.69 / $199.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.24 / $785.24 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.98 / $2,157.98 / $4,315.97