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Washington rates for HCPCS A2015

Phoenix wound matrix, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.79 / $103.93 / $103.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.96 / $91.79 / $154.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,835.25 / $1,977.60 / $5,055.12
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.49 / $2,551.77 / $4,904.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.24 / $785.24 / $785.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,518.64 / $1,518.64 / $1,518.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.75 / $927.95 / $927.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.38 / $1,857.77 / $2,528.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $1,726.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.38 / $59.38 / $59.38