| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $21.00 | $21.00 | $21.00 | |
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 |
Synthetic Resorbable Wound Dressing Sterile 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 |
|---|---|---|---|---|---|
Cigna
| Professional | $21.00 | $21.00 | $21.00 | |
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 |