| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.69 | $1.69 | $1.69 | |
Aetna
| Professional | $1.69 | $1.69 | $1.69 | |
Cigna
| Professional | $1.89 | $1.89 | $1.89 | |
Medica
| Facility | $1.69 | $1.69 | $2.11 |
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
| Facility | $1.69 | $1.69 | $1.69 | |
Aetna
| Professional | $1.69 | $1.69 | $1.69 | |
Cigna
| Professional | $1.89 | $1.89 | $1.89 | |
Medica
| Facility | $1.69 | $1.69 | $2.11 |