| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.80 | $2.80 | $2.80 | |
Aetna
| Professional | $1.69 | $1.69 | $2.80 | |
Cigna
| Professional | $1.89 | $1.89 | $1.89 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Gauze Non-Impregnated 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 | $2.80 | $2.80 | $2.80 | |
Aetna
| Professional | $1.69 | $1.69 | $2.80 | |
Cigna
| Professional | $1.89 | $1.89 | $1.89 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |