| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 |
Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 sq in but less than or equal to 48 sq in
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 |