| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.69 | $1.69 | $2.80 | |
Cigna
| Professional | $1.89 | $1.89 | $1.89 | |
Providence
| Facility | $1.69 | $1.69 | $1.69 | |
Providence
| Professional | $1.89 | $1.89 | $2,250,000.00 |
Gauze, nonimpregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.69 | $1.69 | $2.80 | |
Cigna
| Professional | $1.89 | $1.89 | $1.89 | |
Providence
| Facility | $1.69 | $1.69 | $1.69 | |
Providence
| Professional | $1.89 | $1.89 | $2,250,000.00 |