While the monopoly of the Orthopedists (merger of two large groups), Cardiologists (Alaska Heart Institute) and Neurosurgeons in this town has driven competition out and costs up for their services, lets not forget what the insurance co. and the hospitals do. Hospitals in Alaska charge ridiculous fees with unbelievable mark up of supplies. Facility fees are a goldmine for all the hospitals and surgery centers. No wonder surgery centers, owned by specialists have cropped up, not only in this in this State but nationwide. Orthopedists have their own surgery center and MRI's, Gastroenterologists have their own procedure facilities (Alaska Digestive Center) and the Surgeons use Surgery Center for elective surgeries. Lets not forget the Insurance and Hospital CEO's compensations e.g. Aetna CEO Mark Bertolini: $15 M, Cigna CEO David Cordani: $14.5 M 
http://www.fiercehealthcare.com/payer/top-health-insurance-ceo-pay-exceeds-10-million-2014.