| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $0.15 | $0.15 | $0.15 | |
Cigna
| Professional | $0.17 | $0.17 | $0.17 | |
HMSA
| Professional | $2.63 | $2.75 | $2.75 | |
United
| Professional | $0.19 | $0.43 | $0.62 |
Gauze, nonimpregnated, nonsterile, pad size more than 16 sq in but less than or equal to 48 sq in, without adhesive border, each dressing
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $0.15 | $0.15 | $0.15 | |
Cigna
| Professional | $0.17 | $0.17 | $0.17 | |
HMSA
| Professional | $2.63 | $2.75 | $2.75 | |
United
| Professional | $0.19 | $0.43 | $0.62 |